Journal: British journal of haematology
This retrospective registry study evaluated the impact of stopping systemic immunosuppression within 2 years after allogeneic haematopoietic stem cell transplantation among patients who were alive and progression-free at 2 years.
Among 5061 such patients (median age 48, range 0–79 years):
- 2320 discontinued immunosuppressive therapy within 2 years
- 2741 remained on immunosuppression beyond 2 years
Compared with those who remained on immunosuppression, patients who discontinued within 2 years had:
- Higher 4-year overall survival: 95.3% vs 90.8% (p<0.01)
- Lower 4-year cumulative non-relapse mortality: 3.5% vs 8.6% (p<0.01)
The reduction in non-relapse mortality was consistent across major causes, including:
- Graft-versus-host disease–related deaths
- Infection-related deaths
- Organ failure–related deaths
Continued immunosuppression beyond 2 years was associated with inferior overall survival.
The authors conclude that transplant strategies should aim to minimize the need for prolonged immunosuppression, as successful early discontinuation is associated with better long-term outcomes in allo-HSCT survivors.