Aurelie Ravinet1, Aurelie Cabrespine, Gerard Socié, Noël Milpied, Ibrahim Yakoub Agha, Stephanie Nguyen, Mauricette Michallet, Anne Lise Menard, Natacha Maillard, Mohamad Mohty, Felipe Suarez, Anne Huynh, Tony Marchand, Clémence Deteix, Jill Patrice Cassuto, Sebastien Maury, Patrice Chevallier, Oumedaly Reman, Régis Peffault de Latour, Jacques Olivier Bay. 1. 1 Service d'hématologie Clinique Adulte et de Thérapie Cellulaire, CHU Estaing, Clermont Ferrand, France.2 Clermont Université, Université d'Auvergne, Clermont Ferrand, France.3 Hematologie/Transplantation, Hôpital St Louis, Paris, France.4 University Hospital and University of Bordeaux, Bordeaux, France.5 CHRU de Lille, France.6 Service d'Hématologie Goupe hospitalier Pitié-Salpétrière, Paris, France.7 Hopital Edouard Herriot, Lyon, France.8 Service d'hématologie, Centre Henri Becquerel, Rouen, France.9 Service d'oncologie Hématologique et Thérapie Cellulaire, CHU de Poitiers, Poitiers, France.10 Hopital Saint-Antoine, APHP, Paris, France.11 Université Pierre & Marie Curie, Paris, France.12 INSERM, Paris, France.13 Hôpital Necker, Paris, France.14 Hôpital Purpan CHU Toulouse, France.15 Department of Clinical Hematology, Rennes University Hospital, Rennes, F-35043, France.16 INSERM UMR 917, Rennes1 University, Rennes, France.17 Department of Hematology, University Hospital, Grenoble, France.18 CHU de Nice, Nice, France.19 Department of Hematology, AP-HP, Henri Mondor Hospital, France.20 University Paris Est Créteil (UPEC) Center for Clinical Investigation in Biotherapy, Créteil, France.21 CHU Hotel Dieu Nantes, France.22 CHU Caen, France.
Abstract
BACKGROUND: The impact of antithymocyte globulin (ATG) in the setting of a myeloablative conditioning transplantation remains controversial, especially when using bone marrow (BM) as the stem cell source. METHODS: We therefore conducted a retrospective analysis to investigate the impact of ATG in patients with acute myeloid leukemia or myelodysplastic syndrome receiving myeloablative conditioning followed by a matched 10 of 10 unrelated donor transplant from BM or peripheral blood stem cells (PBSCs). Our study included 356 patients conditioned with cyclophosphamide associated with fractionated total body irradiation or busulfan. RESULTS: Median follow-up was 17.6 months (range, 0-156). The ATG and PBSCs were the only variables that independently decreased the cumulative incidence (CI) of chronic graft-versus-host disease (GvHD) (hazards ratio [HR], 0.4; 95% CI, 0.21-0.73; P < 0.01; and HR, 0.53; 95% CI, 0.30-0.90; P = 0.02, respectively). The ATG had no impact on overall survival, disease-free survival, relapse, and nonrelapse mortality. In the PBSC group (n = 139), ATG was associated with a lower CI of both grades III to IV acute GvHD (HR, 0.17; 95% CI, 0.03-0.91; P = 0.04), chronic GvHD (HR, 0.31; 95% CI, 0.11-0.87; P = 0.03), and GvHD-free/relapse-free survival (HR, 0.48; 95% CI, 0.29-0.80; P < 0.01), whereas these correlations were not significant in the group of patients (n = 217) receiving BM (HR, 0.36; 95% CI, 0.11-1.93; P = 0.06 for grade III-IV acute GvHD; HR, 0.49; 95% CI, 0.22-1.06; P = 0.08 for chronic GvHD; and HR, 0.69; 95% CI, 0.46-1.01; P = 0.06 for GvHD-free/relapse-free survival). CONCLUSIONS: Although our results confirm the recommendation for ATG to be added after PBSC transplantation, no obvious benefit was identified using this approach in the setting of BM transplantation. Only prospective studies may yield definitive answers to this question.
BACKGROUND: The impact of antithymocyte globulin (ATG) in the setting of a myeloablative conditioning transplantation remains controversial, especially when using bone marrow (BM) as the stem cell source. METHODS: We therefore conducted a retrospective analysis to investigate the impact of ATG in patients with acute myeloid leukemia or myelodysplastic syndrome receiving myeloablative conditioning followed by a matched 10 of 10 unrelated donor transplant from BM or peripheral blood stem cells (PBSCs). Our study included 356 patients conditioned with cyclophosphamide associated with fractionated total body irradiation or busulfan. RESULTS: Median follow-up was 17.6 months (range, 0-156). The ATG and PBSCs were the only variables that independently decreased the cumulative incidence (CI) of chronic graft-versus-host disease (GvHD) (hazards ratio [HR], 0.4; 95% CI, 0.21-0.73; P < 0.01; and HR, 0.53; 95% CI, 0.30-0.90; P = 0.02, respectively). The ATG had no impact on overall survival, disease-free survival, relapse, and nonrelapse mortality. In the PBSC group (n = 139), ATG was associated with a lower CI of both grades III to IV acute GvHD (HR, 0.17; 95% CI, 0.03-0.91; P = 0.04), chronic GvHD (HR, 0.31; 95% CI, 0.11-0.87; P = 0.03), and GvHD-free/relapse-free survival (HR, 0.48; 95% CI, 0.29-0.80; P < 0.01), whereas these correlations were not significant in the group of patients (n = 217) receiving BM (HR, 0.36; 95% CI, 0.11-1.93; P = 0.06 for grade III-IV acute GvHD; HR, 0.49; 95% CI, 0.22-1.06; P = 0.08 for chronic GvHD; and HR, 0.69; 95% CI, 0.46-1.01; P = 0.06 for GvHD-free/relapse-free survival). CONCLUSIONS: Although our results confirm the recommendation for ATG to be added after PBSC transplantation, no obvious benefit was identified using this approach in the setting of BM transplantation. Only prospective studies may yield definitive answers to this question.
Authors: Johannes Clausen; Alexandra Böhm; Irene Straßl; Olga Stiefel; Veronika Buxhofer-Ausch; Sigrid Machherndl-Spandl; Josef König; Stefan Schmidt; Hansjörg Steitzer; Martin Danzer; Hedwig Kasparu; Ansgar Weltermann; David Nachbaur Journal: Biomedicines Date: 2017-03-28