Redefining Allogeneic Transplants & Cellular Therapy: Key Takeaways from EBMT 2025 - Episode 7
EBMT 2025 Highlight: Real-World GVHD Prophylaxis: - Insights From the GETH/TC Group Study
Panelists discuss how the Spanish Group for Hematopoietic Transplantation and Cellular Therapy (GETH/TC) real-world study highlights the effectiveness of posttransplant cyclophosphamide (PTCy)-based graft-vs-host disease (GVHD) prophylaxis in reducing acute GVHD incidence and treatment failure rates, supporting its adoption as a standard strategy, particularly in settings with limited donor availability.
Summary for Physicians:
The GETH/TC conducted a comprehensive real-world analysis of GVHD prophylaxis strategies in more than 1500 allogeneic hematopoietic stem cell transplant (alloHSCT) recipients across 13 centers. The study included patients with various donor types, including matched related, matched unrelated, mismatched related, and haploidentical donors.
Key Findings:
- GVHD prophylaxis regimens:
- 66% received PTCy-based regimens
- 13% received calcineurin inhibitor (CNI) plus methotrexate (MTX)
- 7% received CNI plus sirolimus
- 7% received antithymocyte globulin (ATG)-based regimens
- Acute GVHD incidence at day +100:
- Grade II–IV: 29%
- Grade III and IV: 7%
- Comparative effectiveness:
- PTCy-based regimens were associated with a lower cumulative incidence of grade II–IV acute GVHD compared with ATG-based and CNI plusMTX regimens.
- PTCy did not significantly increase the incidence of chronic GVHD.
- First-line treatment failure rates were lower in the PTCy group (28%) compared with the ATG (44%) and CNI plusMTX (32%) groups.
Clinical Implications:
The GETH/TC study underscores the effectiveness of PTCy-based GVHD prophylaxis in reducing acute GVHD incidence without increasing chronic GVHD rates. These findings support the adoption of PTCy-based regimens, particularly in settings where donor availability is limited. The lower rates of treatment failure in the PTCy group suggest improved management of GVHD, potentially leading to better overall outcomes.
These real-world data contribute to the growing body of evidence supporting PTCy as a standard GVHD prophylaxis strategy in alloHSCT.
Nelli Bejanyan reports consulting or advisory role for CareDx, Medexus Pharmaceuticals, Orca Biosystems, AlloVir, TScan Therapeutics, and Pfizer; and research funding from CRISPR Therapeutics. Everett Meyer reports sponsored research from Orca Biosciences, Kyverna; and a scientific advisor role and equity holder for GigaMune, Indee, TRACT, Jura Biosciences.Caspian Oliai reports no relevant disclosures (investigator on the Orca T trial funded by Orca Biosciences). Arpita P. Gandhi reports roles with OncLive, MJH Life Sciences, OrcaBio (research), CareDx (Advisory Board). Amandeep Salhotra reports received funding from Rigel, Bristol Myers Squibb and Orca Biosciences; and speakers bureau for Incyte and Sanofi.
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