EBMT 2021 Van Bekkum Award: Dr Eolia Brissot
GS2 Presidential Symposium - Monday, March 15, 14:30 - 16:00, Auditorium 1
This year’s van Bekkum award has been awarded to Eolia Brissot for her study: “Post-transplantation cyclophosphamide versus antithymoycte globulin after ric regiment allo-hct: first analysis of a prospective randomized multicenter trial in recipients of 10/10 matched donors.”
The winning abstract can be viewed here: https://ebmt2021.abstractserver.com/program/#/details/presentations/1316
Q: Congratulations Eolia on receiving this prestigious award. For delegates that do not know you, please can you tell us a little about yourself?
A: I am working in Saint-Antoine Hospital, Paris in the BMT unit. Current vice-secretary of the Acute Leukaemia Working Party (ALWP) of the EBMT.
Q: What is the background to your study, where did the idea come from and how did you get it started?
A: GVHD prophylaxis remains a challenging task after allo-HCT. The Flu-ivBu combination is a widely used RIC regimen, approved by the European Medicines Agency (EMA) since July 2014. ATG in combination with cyclosporine-A ±mycophenolate mofetil is the backbone for GVHD prophylaxis in this setting. ATG can prevent GVHD with a good efficacy, but at the cost of a higher toxicity and profound immunosuppression, calling for more effective therapies.
The most widely used RIC regimen in France incorporates fludarabine, intermediate doses of IV-busulfan and anti-thymocyte globulins (ATG). While the use of ATG can prevent severe acute and chronic GVHD after allogeneic peripheral blood stem cell (PBSC) transplantation from both HLA-identical sibling and unrelated donors, some data suggested that in-vivo T-cell depletion with ATG in the RIC setting may induce a higher risk of disease relapse. Also, ATG induces profound immune suppression and increases the incidence of opportunistic infections.
On the other hand, high-dose post-transplantation cyclophosphamide (PTCy) was developed to facilitate HLA-haploidentical allo-SCT using unmanipulated bone marrow (BM) cells. PTCy is effective in preventing both acute and chronic GVHD given its capacity to preferentially eliminate allo-reactive T cells and preserve regulatory T cells. Both of which impact allogeneic immune reactions.
Subsequently, the efficacy of PTCy as sole GVHD prophylaxis after myeloablative conditioning when using BM was also shown. However, BM is not the preferred source of stem cells after RIC allo-SCT, and the potential efficacy of PTCy on preventing GVHD when using PBSCs is debated. Thus, the potential efficacy (and cost-effectiveness) of PTCy for GVHD prophylaxis may have a major ATG sparing potential. However, no prospective data were available.
Q: What were the main findings of the study and how will they be applied in clinical practice?
A: With a median follow up of 12 months, we were able to show that the use of PTCy for GVHD prophylaxis resulted in similar outcomes compared to ATG in patients who underwent FB2 allogeneic peripheral blood stem cell transplantation with a 10/10 HLA-matched related or unrelated donor. So, either PTCy or ATG can be used for GVHD prophylaxis in this setting.
Q: Tell us how you felt on hearing you had been awarded the van Bekkum award
A: I felt very honoured and proud to receive this very prestigious award. This is also a great recognition for this impressive collaborative work with my BMT colleagues from the centers who participated in “ATG-Cy GVHD”.
Thanks Eolia and congratulations on your award. We hope you enjoy this year’s EBMT online congress.