Nitin Gupta, Meena Verma, Deepika Gupta, Naveen Vairamoorthy, Saikat Mondal, Naman Bansal, Navneet Mishra, Priyamvadha Ramesh, Shruti Sinha
CMV reactivation was highly prevalent after allo-HSCT and frequently preceded GVHD, supporting a bidirectional temporal relationship between these complications. Older donor age was associated with both CMV reactivation and GVHD. Although survival did not significantly differ according to CMV or GVHD status in this day-100 landmark cohort, clinically important CMV-related complications, including end-organ disease and platelet engraftment failure requiring eltrombopag, remained common. These findings indicate that a standardized pre-emptive strategy did not completely prevent CMV-associated morbidity. Because letermovir was not evaluated in this cohort, any potential benefit of prophylaxis should be interpreted as an inference from external evidence rather than as a direct finding of this study. Prospective multicenter studies incorporating immune reconstitution analyses are warranted.
Post-transplant cyclophosphamide (PTCy) is standard in T cell-replete haploidentical transplants, but its use in matched sibling (MSD) and unrelated donor (MUD) HSCT remains limited, where CNI-MTx ± ATG regimens are still common. Real-world outcome data in matched donor settings, especially from India, are scarce. We retrospectively analysed 48 patients who underwent HSCT between 2018 and 2025. Patients were grouped based on GVHD prophylaxis: CNI/MTx (n = 35) and PTCy (n = 13). All patients were either matched sibling donors (MSD) or MUD. Engraftment, GVHD, CMV reactivations, relapse, survival outcomes, and complications were assessed using SPSS v25. A total of 48 patients (CNI/MTx: 35; PTCy: 13) were analysed. Baseline characteristics, including age, donor type, and diagnosis distribution, were comparable between groups. Acute GVHD occurred in 25.7% vs. 7.7% and chronic GVHD in 42.8% vs. 38.5% of patients, respectively. The mean RFS was 37.1 ± 4.6 vs. 26.1 ± 4.0 months, with median RFS not reached. The 12, 18, and 24 months RFS were 60.0%, 60.0%, and 60.0% for CNI/MTx and 72.5%, 60.4%, and 60.4% for PTCy. There was no significant difference. PTCy-based GVHD prophylaxis appears to be effective and well-tolerated in matched donor HSCT, with low rates of GVHD and transplant-related mortality. Further randomized trials comparing PTCy with CNI + MTx are needed to confirm these findings.