Allogeneic haematopoietic cell transplantation (alloHCT) remains a potentially curative strategy for relapsed or refractory lymphoid malignancies, even in the post-chimeric antigen receptor T-cell and bispecific antibody era. While reduced-intensity conditioning regimens offer lower non-relapse mortality (NRM), relapse rates remain high, and optimal conditioning strategies in the setting of post-transplant cyclophosphamide (PTCy) prophylaxis remain undefined. In this retrospective, international multicentre study, the primary end-point was NRM. We compared treosulfan/fludarabine (Treo/Flu) versus thiotepa/busulfan/fludarabine (TBF) in 178 adults with lymphoid malignancies undergoing first alloHCT with PTCy and peripheral blood grafts. Three-year NRM was 14.0% with Treo/Flu versus 33.0% with TBF. On multivariate analysis, Treo/Flu was associated with significantly lower 3-year NRM (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.22–0.87; p = 0.018). Conditioning regimen was not independently associated with overall survival (OS) or progression-free survival (PFS), and relapse incidence was similar between regimens. Moderate to severe chronic graft-versus-host disease (GVHD) was higher with Treo/Flu (26.0% vs. 9.9%; HR 2.43; 95% CI, 1.09–5.43; p = 0.03), while GVHD-free/relapse-free survival (GFRS) was comparable. Findings were consistent in a prespecified propensity score-matched sensitivity analysis. These findings support Treo/Flu as a potentially safer reduced-toxicity conditioning option than TBF in the context of PTCy-based GVHD prophylaxis for lymphoid malignancies and warrant prospective validation.
Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study / Pena, M., Lazzari, L., Martinez, D.F., Ciceri, F., Balaguer-Rosello, A., Sanz, J., Pascual, M.J., Benzaquen, A., Pinana, J.L., Salas, M.Q., Nieto-Vazquez, A., Espanol, I., Huguet, M., Bento, L., Saez, A.J., Barba, P., Filaferro, S., Carbonell Asins, J.A., Pena, C., Mussetti, A., et al.. - In: BRITISH JOURNAL OF HAEMATOLOGY. - ISSN 0007-1048. - 208:3(2026), pp. 1017-1026. [10.1111/bjh.70367]
Treosulfan/fludarabine versus thiotepa/busulfan/fludarabine for allogeneic haematopoietic cell transplantation in lymphoma in the post-transplant cyclophosphamide era: A GETH-TC study
Lazzari L.;Ciceri F.;
2026-01-01
Abstract
Allogeneic haematopoietic cell transplantation (alloHCT) remains a potentially curative strategy for relapsed or refractory lymphoid malignancies, even in the post-chimeric antigen receptor T-cell and bispecific antibody era. While reduced-intensity conditioning regimens offer lower non-relapse mortality (NRM), relapse rates remain high, and optimal conditioning strategies in the setting of post-transplant cyclophosphamide (PTCy) prophylaxis remain undefined. In this retrospective, international multicentre study, the primary end-point was NRM. We compared treosulfan/fludarabine (Treo/Flu) versus thiotepa/busulfan/fludarabine (TBF) in 178 adults with lymphoid malignancies undergoing first alloHCT with PTCy and peripheral blood grafts. Three-year NRM was 14.0% with Treo/Flu versus 33.0% with TBF. On multivariate analysis, Treo/Flu was associated with significantly lower 3-year NRM (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.22–0.87; p = 0.018). Conditioning regimen was not independently associated with overall survival (OS) or progression-free survival (PFS), and relapse incidence was similar between regimens. Moderate to severe chronic graft-versus-host disease (GVHD) was higher with Treo/Flu (26.0% vs. 9.9%; HR 2.43; 95% CI, 1.09–5.43; p = 0.03), while GVHD-free/relapse-free survival (GFRS) was comparable. Findings were consistent in a prespecified propensity score-matched sensitivity analysis. These findings support Treo/Flu as a potentially safer reduced-toxicity conditioning option than TBF in the context of PTCy-based GVHD prophylaxis for lymphoid malignancies and warrant prospective validation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
