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

Journal of Hematology & Oncology

Ellen Meijer¹  Montserrat Rovira²  Edouard Forcade³  Didier Blaise⁴  Sebastian Giebel⁵  Martin Mistrik⁶  Jaime Sanz⁷  Claude Eric Bulabois⁸  J. J. Cornelissen⁹  Stephan Mielke^1,10  Alexandros Spyridonidis^1,11  Gwendolyn Van Gorkom^1,12  Myriam Labopin^1,13  Riitta Niittyvuopio^1,14  Arnon Nagler^1,15  Fabio Ciceri^1,16  Annalisa Ruggeri^1,16  Laimonas Griskevicius^1,17  Bipin Savani^1,18  Ian Moiseev^1,19  Eric Deconinck^2,20  Mohamad Mohty^2,21  Eolia Brissot^2,21 

[1] Amsterdam University Medical Center, VU Medical Center, Department of Hematology, Cancer Center Amsterdam;Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clínic, University of Barcelona;CHU Bordeaux, Hospital Haut-Leveque;Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes;Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cencer Center and Institute of Oncology;Department of Haematology and Transfusion Medicine, University Hospital and Comenius University;Department of Haematology, University Hospital La Fe, University of Valencia;Department of Hematology, CHU de Grenoble;Department of Hematology, Erasmus University Medical Center;Department of Internal Medicine II, University Hospital of Würzburg;Department of Internal Medicine, Bone Marrow Transplantation Unit, University Hospital of Patras;Dept. Internal Medicine, Hematology/Oncology, University Hospital Maastricht;European Society for Blood and Marrow Transplantation Paris Study Office/CEREST-TC;HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit;Hematology Division, BMT and Cord Blood Bank, Chaim Sheba Medical Center;Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute;Hematology, Oncology & Transfusion Center, Vilnius University Hospital Santaros Klinikos, Vilnius University;Long Term Transplant Clinic, Vanderbilt University Medical Center;R.M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University;Service d’Hématologie, Hopital Jean Minjoz;Sorbonne Université, AP-HP, INSERM UMRs938;

关键词: Post-transplant cyclophosphamide;    Antithymocyte globulin;    Matched unrelated donor;    Acute myeloid leukemia;   

DOI  :  10.1186/s13045-020-00923-0

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown