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

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 -