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Blood. 2015 Aug 20;126(8):1027-32. doi: 10.1182/blood-2014-09-599241. Epub 2015 Jul 9.

Impact of ATG-containing reduced-intensity conditioning after single- or double-unit allogeneic cord blood transplantation.

Author information

1
Hôpital Saint Vincent de Paul, Groupe Hospitalier de l'Institut Catholique de Lille, Hematologie, Lille, France; University Lille 2, Lille, France; Lille Inflammation Research International Center (LIRIC) U995, Lille, France;
2
Eurocord, Paris, France;
3
Eurocord, Paris, France; Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France;
4
Hematology, Institut Paoli Calmettes, Marseille, France;
5
Hôpital Lapeyronie, Montpellier, France;
6
Hematology, University Hospital, Nantes, France;
7
Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands;
8
Hematology, University Hospital, Poitiers, France;
9
Hematology, University Hospital, Bordeaux, France;
10
Hematology, University Medical Center Utrecht, Utrecht, The Netherlands;
11
Division of Hematology, Medical University of Graz, Graz, Austria;
12
Rigshospitalet, Copenhagen, Denmark;
13
Department of Haematological Medicine, King's College London and Kings College Hospital, London, United Kingdom;
14
Department of Haematology/Oncology, University of Regensburg, Regensburg, Germany;
15
Division of Hematology, Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany;
16
Eurocord, Paris, France; Monacord, Monaco;
17
Eurocord, Paris, France; Division of Hematology, Churchill Hospital, Oxford, United Kingdom; and.
18
University Lille 2, Lille, France; Lille Inflammation Research International Center (LIRIC) U995, Lille, France; Hematology, University-Hospital of Lille, France.

Abstract

We analyzed 661 adult patients who underwent single-unit (n = 226) or double-unit (n = 435) unrelated cord blood transplantation (UCBT) following a reduced-intensity conditioning (RIC) consisting of low-dose total body irradiation (TBI), cyclophosphamide, and fludarabine (Cy/Flu/TBI200). Eighty-two patients received rabbit antithymocyte globulin (ATG) as part of the conditioning regimen (ATG group), whereas 579 did not (non-ATG group). Median age at UCBT was 54 years, and diagnoses were acute leukemias (51%), myelodysplastic syndrome/myeloproliferative neoplasm (19%), and lymphoproliferative diseases (30%). Forty-four percent of patients were transplanted with advanced disease. All patients received ≥4 antigens HLA-matched UCBT. Median number of collected total nucleated cells was 4.4 × 10(7)/kg. In the ATG group, on 64 evaluable patients, ATG was discontinued 1 (n = 27), 2 (n = 20), or > 2 days before the graft infusion (n = 17). In multivariate analyses, the use of ATG was associated with decreased incidence of acute graft-versus-host disease (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.17-0.55; P < .0001), higher incidence of nonrelapse mortality (HR, 1.68; 95% CI, 1.16-2.43; P = .0009), and decreased overall survival (HR, 1.69; 95% CI, 1.19-2.415; P = .003). Collectively, our results suggest that the use of ATG could be detrimental, especially if given too close to graft infusion in adults undergoing UCBT following Cy/Flu/TBI200 regimen.

PMID:
26160301
DOI:
10.1182/blood-2014-09-599241
[Indexed for MEDLINE]
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