Allogeneic peripheral blood stem cell transplantation with anti-thymocyte globulin versus allogeneic bone marrow transplantation without anti-thymocyte globulin.

Abstract

We compared severe graft-versus-host-disease (GvHD) free and relapse-free survival and other transplantation outcomes of acute myeloid leukemia (AML) patients given bone marrow (BM) without anti-thymocyte globulin (ATG) versus peripheral blood stem cells (PBSC) with ATG after myeloablative conditioning. In the cohort of patients receiving grafts from a human leukocyte antigen (HLA)-matched sibling donor, patients given PBSC with ATG (n=1,021) and those given BM without ATG (n=1,633) presented comparable severe GvHD-free relapse-free survival (GRSF)(hazard ratio [HR]=0.9, 95% confidence interval [CI]: 0.8-1.1, P=0.5) and overall survival (HR=1.0, 95% CI: 0.8-1.2, P=0.8). They had however, a lower incidence of chronic GvHD (cGvHD) (HR=0.7, 95% CI: 0.6-0.9, P=0.01). In the cohort of patients receiving grafts from HLA-matched unrelated donor , patients given PBSC with ATG (n=2,318) had better severe GvHD-free and relapse-free survival (GRFS) than those given BM without ATG (n=303) (HR=0.8, 95% CI: 0.6-0.9, P=0.001). They also had a lower incidence of cGvHD (HR=0.6, 95% CI: 0.5-0.8, P=0.0006) and better overall survival (HR=0.8, 95% CI: 0.6-1.0, P=0.04). In summary, these data suggest that PBSC with ATG results in comparable (in the case of sibling donor) or significantly better (in the case of unrelated donor) severe GRFS than BM without ATG in patients with AML in complete remission receiving grafts after myeloablative conditioning.

• Authors: Frédéric Baron, Jacques-Emmanue Galimard, Myriam Labopin, Ibrahim Yakoub-Agha, Riitta Niittyvuopio, Nicolaus Kröger, Laimonas Griskevicius, Depei Wu, Edouard Forcade, Carlos Richard, Mahmoud Aljurf, Grzegorz Helbig, Hélène Labussière-Wallet, Mohamad Mohty, Arnon Nagler
• Journal: Haematologica (Haematologica) Vol. 105 Issue 4 Pg. 1138-1146 (04 2020) ISSN: 1592-8721 [Electronic] Italy
• PMID: 31413093 (Publication Type: Journal Article)
• Copyright: Copyright© 2020 Ferrata Storti Foundation.

Chemical References

• Antilymphocyte Serum

Topics

• Antilymphocyte Serum (therapeutic use)
• Bone Marrow Transplantation
• Graft vs Host Disease (epidemiology, etiology)
• Hematopoietic Stem Cell Transplantation
• Humans
• Peripheral Blood Stem Cell Transplantation
• Transplantation Conditioning