The role of anti-thymocyte globulin in allogeneic stem cell transplantation (HSCT) from HLA-matched unrelated donors (MUD) for secondary AML in remission: a study from the ALWP /EBMT

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Arnon Nagler - , Sheba Medical Center at Tel Hashomer (Author)
  • Myriam Labopin - , Sorbonne Paris North University (Author)
  • Nicolaus Kröger - , Jena University Hospital (Author)
  • Thomas Schroeder - , Hospital of the Ludwig-Maximilians-University (LMU) Munich (Author)
  • Tobias Gedde-Dahl - , Oslo University Hospital (Author)
  • Matthias Eder - , Hannover Medical School (MHH) (Author)
  • Georg-Nikolaus Franke - , University Hospital Leipzig (Author)
  • Igor Wolfgang Blau - , Charité – Universitätsmedizin Berlin (Author)
  • Urpu Salmenniemi - , HUCH Comprehensive Cancer Center (Author)
  • Gerard Socie - , Hopital Louis-Mourier (Author)
  • Johannes Schetelig - , Department of internal Medicine I, University Hospital Carl Gustav Carus Dresden (Author)
  • Matthias Stelljes - , University of Münster (Author)
  • Fabio Ciceri - , IRCCS Hospital San Raffaele (Author)
  • Mohamad Mohty - , Sorbonne Paris North University (Author)

Abstract

We compared outcomes, of 1609 patients with secondary acute myeloid leukemia (sAML) undergoing allogeneic transplantation (HSCT) in first complete remission (CR1) from matched unrelated donors (MUD) from 2010 to 2021, receiving or not receiving anti-thymocyte globulin (ATG) (ATG-1308, no ATG-301). Median age was 60.9 (range, 18.5-77.8) and 61.1 (range, 21.8-75.7) years, (p = 0.3). Graft versus host disease (GVHD) prophylaxis was cyclosporin-A with methotrexate (41%) or mycophenolate mofetil (38.2%), without significant differences between groups. Day 28, engraftment (ANC > 0.5 × 109/L) was 92.3% vs 95.3% (p = 0.17), respectively. On multivariate analysis, ATG was associated with lower incidence of grade II-IV and grade III-IV acute GVHD (p = 0.002 and p = 0.015), total and extensive chronic GVHD (p = 0.008 and p < 0.0001), and relapse incidence (RI) (p = 0.039), while non-relapse mortality (NRM) did not differ (p = 0.51). Overall survival (OS), and GVHD-free, relapse-free survival (GRFS) were significantly higher in the ATG vs no ATG group, HR = 0.76 (95% CI 0.61-0.95, p = 0.014) and HR = 0.68 (95% CI 0.57-0.8, p < 0.0001), with a tendency for better leukemia-free survival (LFS), HR = 0.82 (95% CI 0.67-1, p = 0.051). The main causes of death were the original disease, infection, and GVHD. In conclusion, ATG reduces GVHD and improves LFS, OS, and GRFS in sAML patients without increasing the RI, despite sAML being a high-risk disease.

Details

Original languageEnglish
Pages (from-to)1339-1347
Number of pages9
JournalBone marrow transplantation
Volume58
Issue number12
Publication statusPublished - Dec 2023
Peer-reviewedYes

External IDs

Scopus 85169616126

Keywords

Keywords

  • Humans, Middle Aged, Antilymphocyte Serum/therapeutic use, Unrelated Donors, Hematopoietic Stem Cell Transplantation/adverse effects, Leukemia, Myeloid, Acute/drug therapy, Graft vs Host Disease/etiology, Recurrence, Chronic Disease, Retrospective Studies, Transplantation Conditioning/adverse effects