Impact of antithymocyte globulin on outcomes of allogeneic hematopoietic cell transplantation with TBI

[en] The impact of the use of antithymocyte globulin (ATG) following a total body irradiation (TBI)–based myeloablative conditioning regimen has been poorly explored. We retrospectively analyzed 724 patients who underwent a first allogeneic hematopoietic cell transplantation (allo-HCT) following a TBI-based conditioning regimen for acute myeloid leukemia (AML) and compared the outcomes of 251 (35%) patients who received ATG (ATG group) with 473 (65%) patients who did not (non-ATG group). Median follow-up of surviving patients was 59 months (interquartile range, 28-83). The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) for non-ATG and ATG groups in the first 100 days was 33% vs 24%, respectively (P 5 .0098). The 2-year cumulative incidence of chronic graft-versus-host disease (cGVHD) was reduced significantly in the ATG group in comparison with the non-ATG group (46% vs 34%, P 5 .003). Using multivariate analysis, in vivo T-cell depletion (ATG group) was independently associated with a decreased incidence of grade II-IV aGVHD (hazard ratio [HR], 0.28; P, .001), grade III-IV aGVHD (HR, 0.21; P, .001), cGVHD (HR, 0.63; P 5 .02), and nonrelapse mortality (NRM) (HR, 0.54; P 5 .02). Relapse risk, overall survival, and leukemia-free survival were similar between the 2 groups. Our results suggest that the addition of ATG to TBI-based myeloablative conditioning for allo-HCT in AML patients results in a significant reduction in aGVHD and cGVHD, translating into a significant reduction in NRM without increasing the relapse rate. © 2019 American Society of Hematology. All rights reserved.

Disciplines :

Hematology

Author, co-author :

Nagler, Arnon; Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel, European Society for Blood and Marrow Transplantation (EBMT) Acute Leukemia Working Party office, Saint Antoine Hospital, Paris, France

Labopin, Myriam; Department of Haematology, EBMT Paris study office/CEREST-TC, Saint Antoine Hospital, Paris, France

Dholaria, Bhagirathbhai; Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, United States, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 686, Nashville, TN 37232, United States

Niittyvuopio, Riitta; Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland

Maertens, Johan; Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium

Poiré, Xavier; Department of Haematology, Cliniques Universitaires St. Luc, Brussels, Belgium

Cornelissen, Jan; Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands

Reményi, Peter; Department Haematology and Stem Cell Transplant, Dél-pesti Centrumkórház–Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary

Bourhis, Jean Henri; Bone Marrow Transplantation Service, Department of Hematology, Institut de Cancérologie, Gustave Roussy, Villejuif, France

Beguin, Yves ; Université de Liège - ULiège > Département des sciences cliniques > Hématologie

More authors (5 more)

Language :

English

Title :

Impact of antithymocyte globulin on outcomes of allogeneic hematopoietic cell transplantation with TBI

Publication date :

2019

Journal title :

Blood Advances

ISSN :

2473-9529

eISSN :

2473-9537

Publisher :

American Society of Hematology

Volume :

Issue :

Pages :

1950-1960

Peer reviewed :

Peer Reviewed verified by ORBi

Funders :

UZ Gent - Ghent University Hospital
INSERM - Institut National de la Santé et de la Recherche Médicale
ASBMD - American Society for Blood and Marrow Transplantation
BUMC - Baylor University Medical Center
Vanderbilt University
Centre Hospitalier Universitaire Sainte-Justine

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since 16 November 2019

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