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Journal Article
ATG or post-transplant cyclophosphamide to prevent GVHD in matched unrelated stem cell transplantation?
2024
Overview
There is a high risk of GVHD and non-relapse mortality (NRM) after allogeneic stem cell transplantations (alloSCT) from unrelated donors. Prophylaxis with rabbit anti-thymocyte globulin (rATG) is standard in Europe but post-transplantation Cyclophosphamide (PTCy) is an emerging alternative. We analyzed outcomes of rATG (
n
= 7725) vs. PTCy (
n
= 1039) prophylaxis in adult patients with hematologic malignancies undergoing peripheral blood alloSCT from 10/10 antigen-matched unrelated donors (MUD) between January 2018 and June 2021 in the EBMT database. The provided
P
-values and hazard ratios (HR) are derived from multivariate analysis. Two years after alloSCT, NRM in the PTCy group was 12.1% vs. 16.4% in the rATG group;
p
= 0.016; HR 0.72. Relapse was less frequent after PTCy vs. rATG (22.8% vs. 26.6%;
p
= 0.046; HR 0.87). Overall survival after PTCy was higher (73.1% vs. 65.9%;
p
= 0.001, HR 0.82). Progression free survival was better after PTCy vs. rATG (64.9% vs. 57.2%;
p
< 0.001, HR 0.83). The incidence of chronic GVHD was lower after PTCy (28.4% vs. rATG 31.4%;
p
= 0.012; HR 0.77), whereas the incidence and severity of acute GVHD were not significantly different. GVHD-free relapse-free survival was significantly higher in the PTCy arm compared to the rATG arm (2 y incidence: 51% vs. 45%; HR: 0.86 [95% CI 0.75–0.99],
p
= 0.035). In the absence of evidence from randomized controlled trials, our findings support a preference for the use of PTCy in adult recipients of peripheral blood alloSCTs from MUD.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
/ Adult
/ Aged
/ Antilymphocyte Serum - therapeutic use
/ Blood
/ Cyclophosphamide - therapeutic use
/ Donors
/ Female
/ Graft vs Host Disease - etiology
/ Graft vs Host Disease - prevention & control
/ Hematologic Neoplasms - mortality
/ Hematologic Neoplasms - therapy
/ Hematopoietic Stem Cell Transplantation - adverse effects
/ Hematopoietic Stem Cell Transplantation - methods
/ Humans
/ Immunosuppressive Agents - therapeutic use
/ Male
/ Medicine
/ Mud
/ Oncology
/ Survival
