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Post-transplant cyclophosphamide + bortezomib + sitagliptin is an investigational combination regimen being evaluated for the prevention of graft-versus-host disease (GvHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). The regimen utilizes three distinct mechanisms: cyclophosphamide acts as an alkylating agent to selectively deplete alloreactive T cells post-transplant; bortezomib is a proteasome inhibitor that modulates cytokine signaling and induces apoptosis in alloreactive cells; and sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that is hypothesized to enhance regulatory T cell activity and improve hematopoietic engraftment. This combination is being studied by Northwell Health as a calcineurin inhibitor-free and mTOR inhibitor-free prophylaxis strategy for adults with hematologic malignancies receiving reduced-intensity conditioning transplants.
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