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

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Nagler , A , Labopin , M , Dholaria , B , Niittyvuopio , R , Maertens , J , Poire , X , Cornelissen , J , Remenyi , P , Bourhis , J H , Beguin , Y , Malladi , R , Kerre , T , Schroyens , W , Savani , B N & Mohty , M 2019 , ' Impact of antithymocyte globulin on outcomes of allogeneic hematopoietic cell transplantation with TBI ' , Blood advances , vol. 3 , no. 13 , pp. 1950-1960 . https://doi.org/10.1182/bloodadvances.2019000030

Title: Impact of antithymocyte globulin on outcomes of allogeneic hematopoietic cell transplantation with TBI
Author: Nagler, Arnon; Labopin, Myriam; Dholaria, Bhagirathbhai; Niittyvuopio, Riitta; Maertens, Johan; Poire, Xavier; Cornelissen, Jan; Remenyi, Peter; Bourhis, Jean Henri; Beguin, Yves; Malladi, Ram; Kerre, Tessa; Schroyens, Wilfried; Savani, Bipin N.; Mohty, Mohamad
Other contributor: University of Helsinki, HUS Comprehensive Cancer Center



Date: 2019-07-09
Language: eng
Number of pages: 11
Belongs to series: Blood advances
ISSN: 2473-9529
DOI: https://doi.org/10.1182/bloodadvances.2019000030
URI: http://hdl.handle.net/10138/305151
Abstract: 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 = .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 = .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 = .02), and nonrelapse mortality (NRM) (HR, 0.54; P = .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.
Subject: VERSUS-HOST-DISEASE
ANTI-THYMOCYTE GLOBULIN
LEUKEMIA WORKING PARTY
ACUTE MYELOID-LEUKEMIA
BLOOD STEM-CELL
MATCHED UNRELATED DONORS
QUALITY-OF-LIFE
CHRONIC GRAFT
COMPLETE REMISSION
BONE-MARROW
3122 Cancers
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