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Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignancies

Bone Marrow Transplantation volume 50, pages 45–50 (2015)Cite this article

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Abstract

This study aimed to assess the impact of antithymocyte globulin (ATG) on patient outcome in a retrospective series of 91 patients (median age: 12 years) who underwent unrelated single-unit cord blood transplantation (allo-CBT) following a myeloablative conditioning regimen. Cord blood units were HLA-matched (6/6, n=18; 21%), one-Ag mismatched (n=30, 35%) or two-Ag mismatched (n=38; 44%). In this series, the OS, nonrelapse mortality (NRM) and cumulative incidence of relapse were 47±6%, 23±4% and 48±5%, respectively. Among 46 patients who received ATG as part of the conditioning regimen, the incidence of acute and chronic GVHD was lower than that in the group of 45 patients who did not receive ATG (20% vs 43%; P=0.03). However, multivariate statistical analysis revealed that the ATG use was associated with decreased OS and EFS rates and a high incidence of NRM (hazard ratio (HR)=1.99, 95% confidence interval (CI): 1.11–3.59, P=0.02), (HR=1.83, 95% CI: 1.08–3.10, P=0.02) and (HR=2.54, 95% CI: 1.03–6.26, P=0.04), respectively. Therefore, our results do not support the use of ATG as part of a myeloablative-conditioning regimen before single-unit allo-CBT in younger patients with hematological malignancies.

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Acknowledgements

Ibrahim Yakoub-Agha would like to thank the ‘association Capucine’ and ‘l’équipe du CHTI de l’EDHEC’ for their generous support of his clinical and basic research work.

Author contributions

LP designed the study, enrolled patients, contributed to the analysis and wrote the manuscript, MM enrolled patients and commented on the manuscript, AR and LT contributed to data collections, NM enrolled patients and commented on the manuscript, PC and RT contributed to data collection, ML contributed to the study design and wrote the manuscript, EG provided scientific criticism and wrote the manuscript, ML performed the data analysis and IY-A designed and supervised the study, analyzed the data and wrote the manuscript.

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Authors and Affiliations

  1. Onco-hématologie, Université Catholique de Lille, Lille, France

    L Pascal

  2. EA2686, Laboratoire d’Immunologie HLA, CHRU de Lille, Lille, France,

    L Pascal, M Labalette & I Yakoub-Agha

  3. Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, APHP, Paris, France

    M Mohty

  4. Université Pierre et Marie Curie, Paris, France

    M Mohty

  5. INSERM, UMRs 938, Paris, France

    M Mohty

  6. Centre Hospitalier et Universitaire de Nantes, Hématologie Clinique, Nantes, France

    M Mohty & P Chevallier

  7. Eurocord, Hôpital Saint Louis APHP, Université Paris-Diderot, Paris, France

    A Ruggeri, L Tucunduva & E Gluckman

  8. Hôpital Haut-Lévèque, Avenue de Magellan, Pessac, France

    N Milpied & R Tabrizi

  9. Centre International greffes and Acute Leukemia Working Party (ALWP), EBMT Paris Office, Hôpital Saint Antoine, Paris, France,

    M Labopin

  10. UAM Allogreffe de CSH, Centre Hospitalier et Universitaire de Lille, Lille, France

    I Yakoub-Agha

Authors
  1. L Pascal
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  2. M Mohty
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  4. L Tucunduva
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  6. P Chevallier
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  8. M Labalette
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  9. E Gluckman
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  10. M Labopin
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Corresponding author

Correspondence to I Yakoub-Agha.

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Competing interests

MM, IY-A, NM and PC received research support and honoraria from Genzyme Sanofi, whose product is discussed in this study.

The remaining authors declare no conflict of interest.

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Pascal, L., Mohty, M., Ruggeri, A. et al. Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignancies. Bone Marrow Transplant 50, 45–50 (2015). https://doi.org/10.1038/bmt.2014.216

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