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Reduced Intensity Conditioning

Favorable impact of pre-transplant ATG on outcomes of reduced-intensity hematopoietic cell transplants from partially mismatched unrelated donors

Bone Marrow Transplantation volume 49, pages 185–189 (2014)Cite this article

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Abstract

Reduced-intensity conditioning (RIC) permits allogeneic hematopoietic progenitor cell transplantation in patients who would not be considered candidates for transplantation using a myeloablative preparative regimen because of age, comorbidities or prior therapy. In the setting of myeloablative transplantation, use of antithymocyte globulin (ATG) can reduce the risk of GVHD without negatively affecting transplant outcomes; however, limited data exist on the impact of ATG in the setting of RIC, particularly when there is HLA-mismatch. We performed a retrospective analysis of 85 patients who received unrelated donor transplants at our institution for hematologic malignancies following conditioning with fludarabine and melphalan (FluMel), with or without rabbit ATG (6 mg/kg). ATG was targeted to patients receiving HLA-mismatched grafts. With a median follow-up of 36 months, those receiving ATG and a mismatched graft had similar rates of acute and chronic GVHD, relapse, and similar OS compared with those receiving HLA-matched grafts without ATG. In a multivariate analysis, HLA-mismatched donor was not associated with a decrement in OS. We conclude that this intermediate dose of ATG is effective in preventing severe GVHD in the setting of HLA-mismatch, without undue compromise of the graft versus tumor effects on which RIC transplants depend.

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Acknowledgements

We would like to acknowledge the staff and transplant patients at Emory university Hospital and the Winship Cancer Institute. We thank Divya Tiwari Koura for help with figure preparation, and Jolanna Ruiz for assistance with preparation of the manuscript.

Author Contributions

AAL, JMP, HJK and EKW designed the analysis; AAL, JMP, SM and MG abstracted clinical data; all authors participated in the interpretation of results and approved the final manuscript.

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Authors and Affiliations

  1. Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Emory University School of Medicine, Atlanta, GA, USA

    A A Langston, J M Prichard, S Muppidi, A Nooka, M J Lechowicz, S Lonial, R Sinha, M Graiser, J L Kaufman, H J Khoury, C R Flowers & E K Waller

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  1. A A Langston
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Correspondence to A A Langston.

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Langston, A., Prichard, J., Muppidi, S. et al. Favorable impact of pre-transplant ATG on outcomes of reduced-intensity hematopoietic cell transplants from partially mismatched unrelated donors. Bone Marrow Transplant 49, 185–189 (2014). https://doi.org/10.1038/bmt.2013.168

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