Post-transplant cyclophosphamide versus antithymocyte globulin in patients with acute myeloid leukemia in first complete remission undergoing allogeneic stem cell transplantation from 10/10 HLA-matched unrelated donors.

Abstract

BACKGROUND:

Graft-versus-host disease (GVHD) remains a major contributor to mortality and morbidity after allogeneic stem-cell transplantation (allo-HSCT). The updated recommendations suggest that rabbit antithymocyte globulin or anti-T-lymphocyte globulin (ATG) should be used for GVHD prophylaxis in patients undergoing matched-unrelated donor (MUD) allo-HSCT. More recently, using post-transplant cyclophosphamide (PTCY) in the haploidentical setting has resulted in low incidences of both acute (aGVHD) and chronic GVHD (cGVHD). Therefore, the aim of our study was to compare GVHD prophylaxis using either PTCY or ATG in patients with acute myeloid leukemia (AML) who underwent allo-HSCT in first remission (CR1) from a 10/10 HLA-MUD.

METHODS:

Overall, 174 and 1452 patients from the EBMT registry receiving PTCY and ATG were included. Cumulative incidence of aGVHD and cGVHD, leukemia-free survival, overall survival, non-relapse mortality, cumulative incidence of relapse, and refined GVHD-free, relapse-free survival were compared between the 2 groups. Propensity score matching was also performed in order to confirm the results of the main analysis RESULTS: No statistical difference between the PTCY and ATG groups was observed for the incidence of grade II-IV aGVHD. The same held true for the incidence of cGVHD and for extensive cGVHD. In univariate and multivariate analyses, no statistical differences were observed for all other transplant outcomes. These results were also confirmed using matched-pair analysis.

CONCLUSION:

These results highlight that, in the10/10 HLA-MUD setting, the use of PTCY for GVHD prophylaxis may provide similar outcomes to those obtained with ATG in patients with AML in CR1.

• Authors: Eolia Brissot, Myriam Labopin, Ian Moiseev, J J Cornelissen, Ellen Meijer, Gwendolyn Van Gorkom, Montserrat Rovira, Fabio Ciceri, Laimonas Griskevicius, Didier Blaise, Edouard Forcade, Martin Mistrik, Stephan Mielke, Claude Eric Bulabois, Riitta Niittyvuopio, Eric Deconinck, Annalisa Ruggeri, Jaime Sanz, Alexandros Spyridonidis, Bipin Savani, Sebastian Giebel, Arnon Nagler, Mohamad Mohty
• Journal: Journal of hematology & oncology (J Hematol Oncol) Vol. 13 Issue 1 Pg. 87 (07 03 2020) ISSN: 1756-8722 [Electronic] England
• PMID: 32620146 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antilymphocyte Serum
• Immunosuppressive Agents
• Cyclophosphamide
• thymoglobulin

Topics

• Adolescent
• Adult
• Aged
• Allografts
• Antilymphocyte Serum (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Cause of Death
• Combined Modality Therapy
• Cyclophosphamide (therapeutic use)
• Disease-Free Survival
• Female
• Graft Survival
• Graft vs Host Disease (drug therapy, epidemiology, prevention & control)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Histocompatibility
• Humans
• Immunosuppressive Agents (therapeutic use)
• Incidence
• Kaplan-Meier Estimate
• Leukemia, Myeloid, Acute (drug therapy, therapy)
• Male
• Middle Aged
• Propensity Score
• Recurrence
• Remission Induction
• Retrospective Studies
• Unrelated Donors
• Young Adult