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Should anti-thymocyte globulin be added in post-transplant cyclophosphamide based matched unrelated donor peripheral blood stem cell transplantation for acute myeloid leukemia? A study on behalf of the Acute Leukemia Working Party of the EBMT

Bone Marrow Transplantation volume 57, pages 1774–1780 (2022)Cite this article

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Abstract

In this registry-based study which includes acute myeloid leukemia patients who underwent a matched unrelated donor allogeneic peripheral-blood stem cell transplantation in complete remission and received post-transplant cyclophosphamide (PTCY) as graft-versus-host disease (GvHD) prophylaxis, we compared 421 recipients without anti-thymocyte globulin (ATG) with 151 patients with ATG. The only significant differences between PTCY and PTCY + ATG cohorts were the median year of transplant and the follow-up period (2017 vs 2015 and 19.6 vs 31.1 months, respectively, p < 0.0001). Overall, 2-year survival was 69.9% vs 67.1% in PTCY and PTCY + ATG, respectively, with deaths related to relapse (39% vs 43.5%), infection (21.9% vs 23.9%) or GvHD (17.1% vs 17.4%) not differing between groups. On univariate comparison, a significantly lower rate of extensive chronic GvHD was found when ATG was added (9.9% vs 21%, p = 0.029), a finding which was not confirmed in the multivariate analysis. The Cox-model showed no difference between PTCY + ATG and PTCY alone with respect to acute and chronic GvHD of all grades, non-relapse mortality, relapse, leukemia-free survival, overall survival, and GvHD-free-relapse-free survival between study cohorts. Our results highlight that the addition of ATG in PTCY does not provide any extra benefit in terms of further GvHD reduction, better GRFS or better survival.

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Fig. 1: Cumulative incidence of GvHD in patients receiving PTCY or PTCY + ATG.
Fig. 2: Outcomes of patients according to the use of PTCY or PTCY + ATG.

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Data availability

AS, ML, BS, AN, and MM had full access to all the data in the study (available upon data-specific request).

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Acknowledgements

We thank the ALWP-EBMT staff for help with data management. The study was accomplished thanks to the contributing centers of the EBMT registry which provided patient data; a complete list appears in the Supplementary Appendix.

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Authors and Affiliations

  1. Bone Marrow Transplantation Unit and Institute of Cellular Therapy, University of Patras, Patras, Greece

    Alexandros Spyridonidis

  2. EBMT Statistical Unit, Sorbonne Université, Hospital Saint-Antoine, Paris, France

    Myriam Labopin

  3. Department of Hematology, Hospital Saint Antoine, Paris, France

    Eolia Brissot & Mohamad Mohty

  4. Gorbacheva Research Institute, Pavlov Univ., St Petersburg, Russian Federation

    Ivan Moiseev

  5. Erasmus MC Cancer Institute, University Medical Center, Rotterdam, Netherlands

    Jan Cornelissen

  6. Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Goda Choi

  7. Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy

    Fabio Ciceri

  8. Institute of Hematology and Blood Transfusion, Prague, Czech Republic

    Jan Vydra

  9. Dél-pesti Centrumkórház, Budapest, Hungary

    Péter Reményi

  10. Hospital Clinic, Institute of Hematology & Oncology, Barcelona, Spain

    Montserrat Rovira

  11. VU University Medical Center, Amsterdam, Netherlands

    Ellen Meijer

  12. Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France

    Hélène Labussière-Wallet

  13. Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Marseille, France

    Didier Blaise

  14. University Hospital Maastricht, Maastricht, Netherlands

    Gwendolyn van Gorkom

  15. University Hospital Eppendorf, Bone Marrow Transplant Centre, Hamburg, Germany

    Nicolaus Kröger

  16. Bone Marrow Transplant Unit, Medicana International Hospital, Istanbul, Turkey

    Yener Koc

  17. Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland

    Sebastian Giebel

  18. Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut-Medical Center, Beirut, Lebanon

    Ali Bazarbachi

  19. Vanderbilt University Medical Center, Nashville, TN, USA

    Bipin Savani

  20. Hematology Division, Chaim Sheba Medical Center, Tel-Hashomer, Israel

    Arnon Nagler

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  1. Alexandros Spyridonidis
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Contributions

AS, ML, and MM designed the study; ML performed the statistical analyses; AS wrote the paper; BS, AN, and MM revised the paper; EB, IM, JC, GC, FC, JV, PR, MR, EM, HLW, DB, GG, NK, YK, SG, AB, BS, AN, MM were the principal investigators at the centers recruiting the largest numbers of patients for the study. All authors reviewed the final version of the paper.

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Correspondence to Alexandros Spyridonidis.

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The authors declare no competing interests.

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The study protocol was approved by the institutional review board at each site and complied with country-specific regulatory requirements. The study was conducted in accordance with the declaration of the Helsinki and Good Clinical Practice guidelines. Patients provide informed consent authorizing the use of their personal information for research purposes.

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Spyridonidis, A., Labopin, M., Brissot, E. et al. Should anti-thymocyte globulin be added in post-transplant cyclophosphamide based matched unrelated donor peripheral blood stem cell transplantation for acute myeloid leukemia? A study on behalf of the Acute Leukemia Working Party of the EBMT. Bone Marrow Transplant 57, 1774–1780 (2022). https://doi.org/10.1038/s41409-022-01816-1

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