Posttransplant cyclophosphamide versus antithymocyte globulin in patients with acute lymphoblastic leukemia treated with allogeneic hematopoietic cell transplantation from matched unrelated donors: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
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Posttransplant cyclophosphamide versus antithymocyte globulin in patients with acute lymphoblastic leukemia treated with allogeneic hematopoietic cell transplantation from matched unrelated donors: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. / Giebel, Sebastian; Labopin, Myriam; Salmenniemi, Urpu; Socié, Gerard; Bondarenko, Sergey; Blaise, Didier; Kröger, Nicolaus; Vydra, Jan; Grassi, Anna; Bonifazi, Francesca; Czerw, Tomasz; Anagnostopoulos, Achilles; Lioure, Bruno; Ruggeri, Annalisa; Savani, Bipin; Spyridonidis, Alexandros; Sanz, Jaime; Peric, Zinaida; Nagler, Arnon; Ciceri, Fabio; Mohty, Mohamad.
in: CANCER-AM CANCER SOC, Jahrgang 129, Nr. 23, 01.12.2023, S. 3735-3745.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Posttransplant cyclophosphamide versus antithymocyte globulin in patients with acute lymphoblastic leukemia treated with allogeneic hematopoietic cell transplantation from matched unrelated donors: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
AU - Giebel, Sebastian
AU - Labopin, Myriam
AU - Salmenniemi, Urpu
AU - Socié, Gerard
AU - Bondarenko, Sergey
AU - Blaise, Didier
AU - Kröger, Nicolaus
AU - Vydra, Jan
AU - Grassi, Anna
AU - Bonifazi, Francesca
AU - Czerw, Tomasz
AU - Anagnostopoulos, Achilles
AU - Lioure, Bruno
AU - Ruggeri, Annalisa
AU - Savani, Bipin
AU - Spyridonidis, Alexandros
AU - Sanz, Jaime
AU - Peric, Zinaida
AU - Nagler, Arnon
AU - Ciceri, Fabio
AU - Mohty, Mohamad
N1 - © 2023 American Cancer Society.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - BACKGROUND: The aim of this study was to compare two immunosuppressive strategies, based on the use of either rabbit antithymocyte globulin (ATG) or posttransplant cyclophosphamide (PTCY), as a prophylaxis of graft-versus-host disease (GVHD) for patients with acute lymphoblastic leukemia (ALL) in first complete remission who underwent hematopoietic cells transplantation from matched unrelated donors.METHODS: Overall, 117 and 779 adult patients who received PTCY and ATG, respectively, between the years 2015 and 2020 were included in this retrospective study. The median patient age was 40 and 43 years in the PTCY and ATG groups, respectively, and 37% and 35% of patients, respectively, had Philadelphia chromosome-positive ALL.RESULTS: In univariate analysis, the cumulative incidence of acute and chronic GVHD did not differ significantly between the study groups. The cumulative incidence of relapse at 2 years was reduced in the PTCY group (18% vs. 25%; p = .046) without a significant impact on nonrelapse mortality (11% vs. 16% in the ATG group; p = .29). The rates of leukemia-free survival (LFS) and overall survival were 71% versus 59%, respectively (p = .01), and 82% versus 74%, respectively (p = .08). In multivariate analysis, the receipt of ATG compared with PTCY was associated with a reduced risk of extensive chronic GVHD (hazard ratio, 0.54; 95% confidence interval, 0.3-0.98; p = .04) and an increased risk of low LFS (hazard ratio, 1.57; 95% confidence interval, 1.01-2.45; p = .045).CONCLUSIONS: The receipt of ATG compared with PTCY, despite the reduced risk of extensive chronic GVHD, is associated with inferior LFS in adults with ALL who undergo hematopoietic cell transplantation from 10/10 human leukocyte antigen-matched unrelated donors. These findings warrant verification in prospective trials.
AB - BACKGROUND: The aim of this study was to compare two immunosuppressive strategies, based on the use of either rabbit antithymocyte globulin (ATG) or posttransplant cyclophosphamide (PTCY), as a prophylaxis of graft-versus-host disease (GVHD) for patients with acute lymphoblastic leukemia (ALL) in first complete remission who underwent hematopoietic cells transplantation from matched unrelated donors.METHODS: Overall, 117 and 779 adult patients who received PTCY and ATG, respectively, between the years 2015 and 2020 were included in this retrospective study. The median patient age was 40 and 43 years in the PTCY and ATG groups, respectively, and 37% and 35% of patients, respectively, had Philadelphia chromosome-positive ALL.RESULTS: In univariate analysis, the cumulative incidence of acute and chronic GVHD did not differ significantly between the study groups. The cumulative incidence of relapse at 2 years was reduced in the PTCY group (18% vs. 25%; p = .046) without a significant impact on nonrelapse mortality (11% vs. 16% in the ATG group; p = .29). The rates of leukemia-free survival (LFS) and overall survival were 71% versus 59%, respectively (p = .01), and 82% versus 74%, respectively (p = .08). In multivariate analysis, the receipt of ATG compared with PTCY was associated with a reduced risk of extensive chronic GVHD (hazard ratio, 0.54; 95% confidence interval, 0.3-0.98; p = .04) and an increased risk of low LFS (hazard ratio, 1.57; 95% confidence interval, 1.01-2.45; p = .045).CONCLUSIONS: The receipt of ATG compared with PTCY, despite the reduced risk of extensive chronic GVHD, is associated with inferior LFS in adults with ALL who undergo hematopoietic cell transplantation from 10/10 human leukocyte antigen-matched unrelated donors. These findings warrant verification in prospective trials.
KW - Adult
KW - Humans
KW - Antilymphocyte Serum/therapeutic use
KW - Unrelated Donors
KW - Retrospective Studies
KW - Prospective Studies
KW - Bone Marrow
KW - Cyclophosphamide/therapeutic use
KW - Hematopoietic Stem Cell Transplantation/adverse effects
KW - Leukemia, Myeloid, Acute/drug therapy
KW - Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy
KW - Graft vs Host Disease/etiology
KW - Acute Disease
KW - Transplantation Conditioning
U2 - 10.1002/cncr.35004
DO - 10.1002/cncr.35004
M3 - SCORING: Journal article
C2 - 37658621
VL - 129
SP - 3735
EP - 3745
JO - CANCER-AM CANCER SOC
JF - CANCER-AM CANCER SOC
SN - 0008-543X
IS - 23
ER -