Page 296 - Haematologica April 2020

Stem Cell Transplantation
Ferrata Storti Foundation
Haematologica 2020 Volume 105(4):1138-1146
Allogeneic peripheral blood stem cell transplantation with anti-thymocyte globulin versus allogeneic bone marrow transplantation without anti-thymocyte globulin
Frédéric Baron,1 Jacques-Emmanuel Galimard,2-5 Myriam Labopin,2-5 Ibrahim Yakoub-Agha,6 Riitta Niittyvuopio,7 Nicolaus Kröger,8
Laimonas Griskevicius,9 Depei Wu,10 Edouard Forcade,11 Carlos Richard,12 Mahmoud Aljurf,13 Grzegorz Helbig,14 Hélène Labussière-Wallet,15 Mohamad Mohty2-5 and Arnon Nagler2,16
1Laboratory of Hematology, GIGA-I3, University of Liège and CHU of Liège, Liege, Belgium; 2EBMT Paris study office/CEREST-TC, Paris, France; 3Department of Haematology, Saint Antoine Hospital, Paris, France; 4Sorbonne University, Centre De Recherche Saint Antoine, INSERM UMR938, Paris, France; 5Sorbonne University, Paris, France; 6University of Lille, INSERM, and CHU of Lille, INFINITE U1286, Lille, France; 7HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland; 8University Hospital Eppendorf, Bone Marrow Transplantation Center, Hamburg, Germany; 9Institute of Clinical Medicine, Vilnius University and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; 10First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, China; 11CHU Bordeaux Hôpital Haut- Leveque, Pessac, France; 12Hospital U. Marqués de Valdecilla, Servicio de Hematología- IDIVAL, Santander, Spain; 13King Faisal Specialist Hospital & Research Centre Oncology, Riyadh, Saudi Arabia; 14Silesian Medical Academy, University Department of Haematology and Bone Marrow Transplantation, Katowice, Poland; 15Centre Hospitalier Lyon Sud, Service Hematologie, Lyon, France and 16Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
ABSTRACT
We compared severe graft-versus-host-disease (GvHD) free and relapse-free survival and other transplantation outcomes of acute myeloid leukemia (AML) patients given bone marrow (BM) with- out anti-thymocyte globulin (ATG) versus peripheral blood stem cells (PBSC) with ATG after myeloablative conditioning. In the cohort of patients receiving grafts from a human leukocyte antigen (HLA)-matched sibling donor, patients given PBSC with ATG (n=1,021) and those given BM without ATG (n=1,633) presented comparable severe GvHD-free relapse- free survival (GRSF)(hazard ratio [HR]=0.9, 95% confidence interval [CI]: 0.8-1.1, P=0.5) and overall survival (HR=1.0, 95% CI: 0.8-1.2, P=0.8). They had however, a lower incidence of chronic GvHD (cGvHD) (HR=0.7, 95% CI: 0.6-0.9, P=0.01). In the cohort of patients receiving grafts from HLA- matched unrelated donor , patients given PBSC with ATG (n=2,318) had better severe GvHD-free and relapse-free survival (GRFS) than those given BM without ATG (n=303) (HR=0.8, 95% CI: 0.6-0.9, P=0.001). They also had a lower incidence of cGvHD (HR=0.6, 95% CI: 0.5-0.8, P=0.0006) and better overall survival (HR=0.8, 95% CI: 0.6-1.0, P=0.04). In summary, these data suggest that PBSC with ATG results in comparable (in the case of sibling donor) or significantly better (in the case of unrelated donor) severe GRFS than BM without ATG in patients with AML in complete remission receiving grafts after myeloablative conditioning.
Introduction
A number of phase III trials have compared peripheral blood stem cells (PBSC) with bone marrow (BM) as the stem cell source for allogeneic hematopoietic cell transplantation in patients given grafts after myeloablative regimens.1,2 A meta- analysis of trials performed in patients given grafts from human leukocyte antigen (HLA)-matched sibling donors (MSD) revealed that the use PBSC of instead of BM was associated with a higher incidence of grade III-IV acute graft-versus-host dis-
Correspondence:
FRÉDÉRIC BARON
f.baron@ulg.ac.be
Received: May 28, 2019. Accepted: August 13, 2019. Pre-published: August 14, 2019.
doi:10.3324/haematol.2019.227603
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/4/1138
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