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Bone Marrow Transplant. 2018 Apr;53(4):431-437. doi: 10.1038/s41409-017-0043-y. Epub 2018 Jan 12.

Impact of antithymocyte globulin doses in reduced intensity conditioning before allogeneic transplantation from matched sibling donor for patients with acute myeloid leukemia: a report from the acute leukemia working party of European group of Bone Marrow Transplantation.

Author information

1
Department of Hematology, Institut Paoli Calmettes, Marseille, France.
2
CRCM and Aix Marseille University, Marseille, France.
3
Department of Hematology, University Hospital Saint Antoine, APHP, Paris, France.
4
EBMT ALWP Office, Pierre and Marie Curie University, Paris, France.
5
Department of Hematology, University Hospital Nantes, Nantes, France.
6
Department of Hematology, University Hospital Hautepierre, Strasbourg, France.
7
Department of Hematology, University Hopital St Louis, APHP, Paris, France.
8
Department of Hematology, University Insitute of cancer of Toulouse-Oncopole, Toulouse, France.
9
Department of Hematology, Institut Gustave Roussy, Villejuif, France.
10
Department of Hematology, University Hospital A. Michallon, Grenoble, France.
11
Department of Hematology, University Hospital Nancy, Vandoeuvre-lès-Nancy, France.
12
Department of Hematology, King's College Hospital, London, UK.
13
Department of Hematology, University Hospital La Miletrie, Poitiers, France.
14
Department of Hematology, University Hospital Lyon Sud, Lyon, France.
15
Department of Hematology, University Hospital Montpellier, Montpellier, France.
16
Department of Hematology, San Raffaele Hospital, Milano, Italy.
17
Department of Hematology, University of Liège, Liège, Belgium.
18
Department of Hematology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
19
Department of Hematology, University Hospital Saint Antoine, APHP, Paris, France. mohamad.mohty@inserm.fr.
20
EBMT ALWP Office, Pierre and Marie Curie University, Paris, France. mohamad.mohty@inserm.fr.

Abstract

Antithymocyte globulin (ATG) is commonly used for graft-vs.-host disease (GVHD) prophylaxis in unrelated donor allogeneic transplantation (Allo-HSCT). However, its use is still controversial in matched sibling donor (MSD) Allo-HSCT, notably after reduced intensity conditioning (RIC). ATG dose may influence the outcome, explaining in part the discordant conclusions in MSD Allo-HSCT. We, therefore, analyzed the impact of ATG doses in patients with acute myeloid leukemia in first complete remission undergoing RIC Allo-HSCT from a MSD. We analyzed 234 patients from the EBMT registry and compared outcome according to given ATG dose (high dose: ≥ 6 mg/kg, n = 39 or low dose: < 6 mg/kg, n = 195). No difference was found in the cumulative incidence of acute (grade 2-4: high dose vs. low dose: 21% vs. 13%, p = 0.334; adjusted hazard ratio (HR): 1.20, p = 0.712) and chronic GVHD (extensive: high dose vs. low dose: 19% vs. 18%, p = 0.897; adjusted HR: 1.01, p = 0.980). In contrast, high dose of ATG significantly increased the incidence of relapse (52% vs. 26%, p = 0.011; adjusted HR: 1.31, p = 0.001) leading to impaired outcome (HR progression-free survival (PFS): 1.23, p = 0.002; HR overall survival (OS): 1.17, p = 0.029; HR GVHD and relapse-free survival (GRFS): 1.20, p = 0.005). We conclude that an ATG dose <6 mg/kg is sufficient for GVHD prophylaxis, while higher doses impair disease control and outcome.

PMID:
29330391
DOI:
10.1038/s41409-017-0043-y
[Indexed for MEDLINE]
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