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Stem cell transplantation

The impact of anti-thymocyte globulin on the outcomes of Patients with AML with or without measurable residual disease at the time of allogeneic hematopoietic cell transplantation


Measurable residual disease (MRD) status pre-allogeneic hematopoietic cell transplantation (allo-HCT) has been shown to predict transplant outcomes. We investigated the effect of Anti-Thymocyte Globulin (ATG) on acute myelogenous leukemia (AML) relapse by pretransplant MRD status. AML patients undergoing allo-HCT in first complete remission from either a matched sibling or unrelated donor during the 2006–2017 period were selected. Outcomes of 1509 patients (MRD+, n = 426) were studied. ATG was used in 561 (52%) and 239 (58%) patients within the MRD and MRD+ cohorts, respectively. In MRD patients, ATG did not affect relapse incidence (RI) (HR = 0.80, p = 0.17), but was associated with reduced incidence of grade II–IV acute GVHD, grade II–IV and chronic GVHD, reduced nonrelapse mortality (HR = 0.66, p = 0.05), improved leukemia-free survival (HR = 0.74, p = 0.02), overall survival (HR = 0.69, p = 0.01), and GVHD-relapse free survival (HR = 0.62, p < 0.01). In MRD+ patients, ATG was associated with a lower incidence of chronic GVHD (total, HR 0.56 p = 0.03; extensive, HR 0.40 P = 0.01), without an impact on other allo-HCT outcome parameters, including RI(HR = 1.02, p = 0.92). The use of ATG was associated with reduced risk for GVHD. ATG did not increase RI, even in high-risk AML patients who were MRD+ before allo-HCT.

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We sincerely thank the centers of the EBMT and national registries for contributing patient information and data collection. Supporting Information is available at the EBMT website. Reporting institutions included in this study are available in the Online Supporting Information Appendix.

Authors contributions

AN, MM, and ML—contributed to the conception and design of the study; BD, AN, BNS, ML, MM, LL, SOC—contributed to the writing of the manuscript; AR, MAM, PK, EF, XH, FA, LC, AB, MM, DB, PBS, YA, RH, DCR, PO, AB, SS, RR, PL, JG, MM, HML, KB, SG, FB, FC, JE, NCG, AS, and CS—critically reviewed the manuscript and all authors approved the final version of manuscript.

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Correspondence to Bhagirathbhai Dholaria.

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MM and IY-A have received research support and honoraria from Sanofi. The other authors declare that they have no conflict of interest.

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Nagler, A., Dholaria, B., Labopin, M. et al. The impact of anti-thymocyte globulin on the outcomes of Patients with AML with or without measurable residual disease at the time of allogeneic hematopoietic cell transplantation. Leukemia 34, 1144–1153 (2020).

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