Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation.

Abstract

The use of anti-thymocyte globulin (ATG) has represented the standard of care in graft-versus-host disease (GVHD) prophylaxis in patients undergoing a mismatched unrelated donor (MMUD) transplant. The safety and feasibility of posttransplant cyclophosphamide (PTCY) in this setting have been reported recently, but no study has compared the outcomes of PTCY vs ATG in 9/10 MMUD transplants. Using the registry data of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we performed a matched-pair analysis comparing those 2 strategies in a 9/10 MMUD setting. Ninety-three patients receiving PTCY were matched with 179 patients receiving ATG. A significantly lower incidence of severe acute GVHD was observed with PTCY compared with ATG. Recipients of the former also showed higher leukemia-free survival and GVHD/relapse-free survival (GRFS). When performing a subgroup analysis including patients receiving peripheral blood stem cells, being in complete remission, or receiving the same associated immunosuppressive agents, superiority of PTCY over ATG was confirmed. Similar to the haploidentical setting, use of PTCY is an effective anti-GVHD prophylaxis in the 9/10 MMUD transplant. Use of PTCY may also provide better outcomes in long-term disease control. These results need confirmation in large prospective randomized trials.

• Authors: Giorgia Battipaglia, Myriam Labopin, Nicolaus Kröger, Antonin Vitek, Boris Afanasyev, Inken Hilgendorf, Johannes Schetelig, Arnold Ganser, Didier Blaise, Maija Itälä-Remes, Jakob R Passweg, Francesca Bonifazi, Jurgen Finke, Annalisa Ruggeri, Arnon Nagler, Mohamad Mohty
• Journal: Blood (Blood) Vol. 134 Issue 11 Pg. 892-899 (09 12 2019) ISSN: 1528-0020 [Electronic] United States
• PMID: 31270102 (Publication Type: Journal Article)
• Copyright: © 2019 by The American Society of Hematology.

Chemical References

• Antilymphocyte Serum
• Cyclophosphamide

Topics

• Adult
• Aged
• Antilymphocyte Serum (administration & dosage, adverse effects)
• Blood Grouping and Crossmatching (adverse effects)
• Cyclophosphamide (administration & dosage, adverse effects)
• Drug Administration Schedule
• Female
• Graft vs Host Disease (prevention & control)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Histocompatibility Testing (adverse effects)
• Humans
• Leukemia, Myeloid, Acute (immunology, therapy)
• Male
• Middle Aged
• Retrospective Studies
• Transplantation Conditioning (adverse effects, methods)
• Transplantation Immunology
• Transplantation, Homologous
• Unrelated Donors
• Young Adult