A NEW study has demonstrated that adding itacitinib, a JAK-1 selective inhibitor, to standard graft-versus-host disease (GvHD) prophylaxis in haploidentical hematopoietic cell transplantation (haplo-HCT) is safe and well-tolerated, improving patient outcomes without impairing engraftment.
Haplo-HCT, increasingly used for treating haematologic malignancies, still carries significant risks, including life-threatening GvHD and cytokine release syndrome (CRS). While post-transplant cyclophosphamide (PtCy) has enhanced GvHD prevention, complications remain prevalent. Itacitinib, which targets key cytokines involved in GvHD and CRS, was tested for its ability to mitigate these issues and improve overall survival.
In this open-label, single-arm study, 42 patients received itacitinib daily starting three days before transplantation and continuing for up to 180 days. The results were promising: none of the patients experienced grade 2-5 CRS, with 22% having grade 0 and 78% grade 1 CRS. Importantly, there were no cases of primary graft failure or grade 3-4 acute GvHD. The cumulative incidence of grade 2 acute GvHD at 100 days was 21.9%, and only 5% of patients developed moderate or severe chronic GvHD within a year. Additionally, the study reported a 1-year overall survival rate of 80%, with a 2-year relapse rate of 14%.
These findings suggest that itacitinib, in combination with PtCy, offers a promising approach to enhancing patient outcomes post-haplo-HCT, with low rates of complications and encouraging survival data.
Helena Bradbury, EMJ
Reference
Abboud R et al. Itacitinib for prevention of graft-versus-host disease and cytokine release syndrome in haploidentical transplantation. Blood. 2024. doi: 10.1182/blood.2024026497.
