The impact of anti-thymocyte globulin on the outcomes of Patients with AML with or without measurable residual disease at the time of allogeneic hematopoietic cell transplantation.

Abstract

Measurable residual disease (MRD) status pre-allogeneic hematopoietic cell transplantation (allo-HCT) has been shown to predict transplant outcomes. We investigated the effect of Anti-Thymocyte Globulin (ATG) on acute myelogenous leukemia (AML) relapse by pretransplant MRD status. AML patients undergoing allo-HCT in first complete remission from either a matched sibling or unrelated donor during the 2006-2017 period were selected. Outcomes of 1509 patients (MRD+, n = 426) were studied. ATG was used in 561 (52%) and 239 (58%) patients within the MRD- and MRD+ cohorts, respectively. In MRD- patients, ATG did not affect relapse incidence (RI) (HR = 0.80, p = 0.17), but was associated with reduced incidence of grade II-IV acute GVHD, grade II-IV and chronic GVHD, reduced nonrelapse mortality (HR = 0.66, p = 0.05), improved leukemia-free survival (HR = 0.74, p = 0.02), overall survival (HR = 0.69, p = 0.01), and GVHD-relapse free survival (HR = 0.62, p < 0.01). In MRD+ patients, ATG was associated with a lower incidence of chronic GVHD (total, HR 0.56 p = 0.03; extensive, HR 0.40 P = 0.01), without an impact on other allo-HCT outcome parameters, including RI(HR = 1.02, p = 0.92). The use of ATG was associated with reduced risk for GVHD. ATG did not increase RI, even in high-risk AML patients who were MRD+ before allo-HCT.

• Authors: Arnon Nagler, Bhagirathbhai Dholaria, Myriam Labopin, Gerard Socie, Anne Huynh, Maija Itälä-Remes, Eric Deconinck, Ibrahim Yakoub-Agha, Jean-Yves Cahn, Jean-Henri Bourhis, Hélène Labussière-Wallet, Sylvain Chantepie, Jordi Esteve, Bipin Savani, Mohamad Mohty
• Journal: Leukemia (Leukemia) Vol. 34 Issue 4 Pg. 1144-1153 (04 2020) ISSN: 1476-5551 [Electronic] England
• PMID: 31728052 (Publication Type: Journal Article)

Chemical References

• Antilymphocyte Serum
• Immunosuppressive Agents

Topics

• Adolescent
• Adult
• Aged
• Antilymphocyte Serum (therapeutic use)
• Female
• Follow-Up Studies
• Graft vs Host Disease (drug therapy, etiology, mortality, pathology)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Leukemia, Myeloid, Acute (pathology, therapy)
• Male
• Middle Aged
• Neoplasm, Residual (drug therapy, etiology, mortality, pathology)
• Prognosis
• Retrospective Studies
• Survival Rate
• Transplantation Conditioning
• Transplantation, Homologous
• Young Adult