Page 89 - 2021_06-Haematologica-web

Bone Marrow Transplantation
Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia
Ferrata Storti Foundation
Haematologica 2021 Volume 106(6):1591-1598
Arnon Nagler,1* Abraham S. Kanate,2* Myriam Labopin,3* Fabio Ciceri,4 Emanuele Angelucci,5 Yener Koc,6 Zafer Gülbas,7 William Arcese,8 Johanna Tischer,9 Pietro Pioltelli,10 Hakan Ozdogu,11 Boris Afanasyev,12 Depei Wu,13 Mutlu Arat,14 Zinaida Peric,15 Sebastian Giebel,16 Bipin Savani17 and Mohamad Mohty18
1Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel; 2West Virginia University, Morgantown, WV, USA; 3Department of Hematology and EBMT Paris study office / CEREST-TC, Saint Antoine Hospital, Paris, France; 4Ospedale San Raffaele s.r.l., Milano, Italy; 5Ospedale San Martino, Department of Hematology II, Genova, Italy; 6Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey; 7Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey; 8¨Tor Vergata¨ University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata, Rome, Italy; 9Klinikum Grosshadern, Med. Klinik III, Munich, Germany; 10Ospedale San Gerardo, Clinica Ematologica dell’Universita Milano-Biocca, Monza, Italy; 11Baskent University Hospital, Hematology Division, Bone Marrow Transplantation Unit, Adana, Turkey; 12First State Pavlov Medical University of St. Petersburg, Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology, and Transplantation, St. Petersburg, Russia; 13First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, China; 14Florence Nightingale Sisli Hospital, Hematopoietic Stem Cell Transplantation Unit, Istanbul, Turkey; 15University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia; 16Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland; 17Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA and 18Department of Hematology and EBMT Paris study office / CEREST-TC, Saint Antoine Hospital, INSERM UMR 938 and Université Pierre et Marie Curie, Paris, France
*AN, ASK and ML contributed equally as co-first authors.
ABSTRACT
Graft-versus-host disease (GvHD) prophylaxis for unmanipulated haploidentical hematopoietic cell transplantation includes post- transplant cyclophosphamide (PTCy) and anti-thymocyte globu- lin (ATG). Utilizing data in the European Society for Blood and Marrow Transplantation registry, we compared ATG- versus PTCy-based GvHD prophylaxis in 434 adults with acute lymphoblastic leukemia undergo- ing haploidentical hematopoietic cell transplantation. Of the 434 patients included in this study, ATG was used in 98 and PTCy in 336.. The median follow-up was approximately 2 years. The baseline charac- teristics of the patients were similar between the groups except that the ATG group was more likely to have had relapsed/refractory acute lym- phoblastic leukemia (P=0.008), had conditioning not including total body irradiation (P<0.001), have had peripheral blood as the source of their grafts (P≤0.001) and to have been transplanted in an earlier time- period (median year of transplantation: 2011 vs. 2015). The 100-day rates of grade II-IV and III-IV acute GvHD were similar in the ATG and PTCy groups, as were 2-year chronic GvHD rates. On multivariate analysis, leukemia-free survival and overall survival were better with PTCy than with ATG prophylaxis. Relapse incidence was lower in the PTCy group (P=0.03), while non-relapse mortality was not different. Advanced disease and lower performance score were associated with poorer leukemia-free survival and overall survival and advanced disease
Correspondence:
ABRAHAM S. KANATE
askanate@hsc.wvu.edu
Received: January 12, 2020. Accepted: April 28, 2020. Pre-published: April 30, 2020.
https://doi.org/10.3324/haematol.2020.247296
©2021 Ferrata Storti Foundation
Material published in Haematologica is covered by copyright. All rights are reserved to the Ferrata Storti Foundation. Use of published material is allowed under the following terms and conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode. Copies of published material are allowed for personal or inter- nal use. Sharing published material for non-commercial pur- poses is subject to the following conditions: https://creativecommons.org/licenses/by-nc/4.0/legalcode, sect. 3. Reproducing and sharing published material for com- mercial purposes is not allowed without permission in writing from the publisher.
haematologica | 2021; 106(6)
1591
ARTICLE