The Effect of Post-Transplant Cyclophosphamide Administration on Graft-Versus-Host Disease in Allogeneic Bone Marrow Transplantation

ABSTRACT Aim. We aimed to compare patients receiving cyclophosphamide treatment post-transplant with those receiving standard graft versus host disease (GVHD) prophylaxis in terms of GVHD development, disease relapse, overall survival, transplant-related mortality and infection development. Methods: The data of 78 patients who underwent allogeneic stem cell transplantation (AHSCT)at Medicana Izmir Hospital between January 2022 and June 2024 were retrospectively evaluated. Results: Of the patients, 36 (46.2%) were female, and 42 (53.8%) were male. Myeloablative related AHSCT was performed on 38 patients (48.7%), myeloablative unrelated on 26 patients (33.3%), and haploidentical on 14 patients (17.9%). Acute GVHD developed in 42 patients (53.8%),Regarding the clinical and laboratory variables affecting acute GVHD, only ferritin (p=0.016) was found to be significantly lower in the group with acute GVHD, and acute GVHD was significantly less observed in the group that received post-transplant cyclophosphamide (p. 0.032).In 15 patients (19.2%), chronic GVHD developed following acute GVHD. It was found that chronic GVHD developed more frequently in those who did not receive post-transplant cyclophosphamide (p=0.0001), in sibling transplants (p=0.037), in those without febrile neutropenia (p=0.021), and in those with high CMV-DNA levels (p=0.040). The median OS (months) was determined as 79.16 months. Median OS (months) was higher in patients with good AML cytogenetic risk group (p< 0.001) and in patients who underwent transplantation in first remission (p=0.021) has been found. In conclusion; Cyclophosphamide administration after allogeneic bone marrow transplantation can significantly reduce the development of acute and chronic GVHD.