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Acute Leukemias

Antithymocyte globulins and chronic graft-vs-host disease after myeloablative allogeneic stem cell transplantation from HLA-matched unrelated donors: a report from the Sociéte Française de Greffe de Moelle et de Thérapie Cellulaire

Leukemia volume 24, pages 1867–1874 (2010)Cite this article

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Abstract

This retrospective report assessed the impact of rabbit antithymocyte globulins (ATG), incorporated within a standard myeloablative conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT) using human leukocyte antigen-matched unrelated donors (HLA-MUD), on the incidence of acute and chronic graft-vs-host disease (GVHD). In this series of leukemia patients, 120 patients (70%) did not receive ATG (‘no-ATG’ group), whereas 51 patients received ATG (‘ATG’ group). With a median follow-up of 30.3 months, the cumulative incidence of grade 3–4 acute GVHD was 36% in the no-ATG group and 20% in the ATG group (P=0.11). The cumulative incidence of extensive chronic GVHD was significantly lower in the ATG group as compared to the no-ATG group (4 vs 32%, respectively; P=0.0017). In multivariate analysis, the absence of use of ATG was the strongest parameter associated with an increased risk of extensive chronic GVHD (relative risk)=7.14, 95% CI: 1.7–33.3, P=0.008). At 2 years, the probability of nonrelapse mortality, relapse, overall and leukemia-free survivals was not significantly different between the no-ATG and ATG groups. We conclude that the addition of ATG to GVHD prophylaxis resulted in decreased incidence of extensive chronic GVHD without an increase in relapse or nonrelapse mortality, and without compromising survival after myeloablative allo-SCT from HLA-MUD.

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Acknowledgements

M Mohty thank the ‘Région Pays de Loire’, the ‘Association pour la Recherche sur le Cancer (ARC)’, the ‘Fondation de France’, the ‘Fondation contre la Leucémie’, the ‘Agence de Biomédecine’, the ‘Association Cent pour Sang la Vie’, and the ‘Association Laurette Fuguain’, for their generous and continuous support for his clinical and basic research work.

Authorship and DisclosuresAll authors listed in the article have contributed substantially to this work. Conception and design: M Mohty, H Espérou, and I Yakoub-Agha. Statistical analysis: M Mohty and M Labopin. Patient recruitment and clinical care: M Mohty, G Socié, N Milpied, N Ifrah, Y Hicheri, R Tabrizi, N Dhedin, M Michallet, A Buzyn, J-Y Cahn, J-H Bourhis, D Blaise, H Espérou and I Yakoub Agha. Collection and assembly of data: M Mohty, M L Balère, A Buzyn, H Espérou and I Yakoub-Agha. Manuscript writing and revisions: M Mohty. Final approval of manuscript: M Mohty, ML Balère, G Socié, N Milpied, R Tabrizzi, N Ifrah, Y Hicheri, N Dhedin, M Michallet, A Buzyn, J-Y Cahn, J-H Bourhis, D Blaise, C Raffoux, H Espérou and I Yakoub-Agha.

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Authors and Affiliations

  1. Hematology Department, Centre Hospitalier Universitaire Hôtel-Dieu, Université de Nantes, CRCNA INSERM U892 and Centre d’investigation Clinique (CI2C), Nantes, France

    M Mohty & N Milpied

  2. Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris and UPMC Université Paris 06, UMR-S 938, Paris, France

    M Labopin

  3. Agence de Biomédecine, France Greffe de Moelle, Paris, France

    M L Balère, C Raffoux & H Espérou

  4. Service de greffe de moelle osseuse, Hopital Saint-Louis, Paris, France

    G Socié & H Espérou

  5. Hematology Department, CHU Haut-Leveque, Pessac, France

    R Tabrizi

  6. Hematology Department, CHU d’Angers, Angers, France

    N Ifrah

  7. Hematology Department, Hopital Henri Mondor, Creteil, France

    Y Hicheri

  8. Hematology Department, Hopital de la Pitié –Salpetriere, Paris, France

    N Dhedin

  9. Hematology Department, CHU de Lyon, Lyon, France

    M Michallet

  10. Hematology Department, Hopital Necker-Enfants maladies, Paris, France

    A Buzyn

  11. Hematology Department, CHU de Grenoble and TIMC-TheREx (UMR 5525 CNRS-UJF), Grenoble, France

    J-Y Cahn

  12. Hematology Department, Institut Gustave-Roussy, Villejuif, France

    J-H Bourhis

  13. Unite de Transplantation et de Therapie cellulaire (U2T), Universite de la Méditerranée, INSERM UMR 891, Institut Paoli-Calmettes, Marseille, France

    D Blaise

  14. Hematology Department, CHU de Lille, Lille, France

    I Yakoub-Agha

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  1. M Mohty
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Correspondence to M Mohty.

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Competing interests

Dr Mohty, Dr Milpied, Dr Blaise, Dr Michallet and Dr Buzyn have acted as a consultant to Genzyme whose product is discussed in this article.

Appendix

Appendix

We thank all other SFGM-TC participating centers who contributed to this study: CHU Hotel-Dieu, Paris (B Rio), CHU de Besancon (E Deconinck), CHU de Saint-Etienne (D Guyotat), CHU de Nice (A Sirvent), CHU de Toulouse (M Attal, A Hyun), CHU de Strasbourg (K Bilger, B Lioure), CHU de Poitiers (F Guilhot), CHU de Rennes (T Lamy), CHU de Rouen (N Contentin) and CHU de Brest (C Berthou).

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Mohty, M., Labopin, M., Balère, M. et al. Antithymocyte globulins and chronic graft-vs-host disease after myeloablative allogeneic stem cell transplantation from HLA-matched unrelated donors: a report from the Sociéte Française de Greffe de Moelle et de Thérapie Cellulaire. Leukemia 24, 1867–1874 (2010). https://doi.org/10.1038/leu.2010.200

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