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  3. 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

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

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Giebel S.
  • Labopin M.
  • Salmenniemi U.
  • Socié G.
  • Bondarenko S.
  • Blaise D.
  • Kröger N.
  • Vydra J.
  • Grassi A.
  • Bonifazi F.
  • Czerw T.
  • Anagnostopoulos A.
  • Lioure B.
  • Ruggeri A.
  • Savani B.
  • Spyridonidis A.
  • Peric Z.
  • Nagler A.
  • Ciceri F.
  • Mohty M.

Grupos

Abstract

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. © 2023 American Cancer Society.

Datos de la publicación

ISSN/ISSNe:
0008-543X, 1097-0142

CANCER  WILEY

Tipo:
Article
Páginas:
3735-3745
PubMed:
37658621
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
2,463 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 16

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Keywords

  • Acute Disease; Adult; Antilymphocyte Serum; Bone Marrow; Cyclophosphamide; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myeloid, Acute; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prospective Studies; Retrospective Studies; Transplantation Conditioning; Unrelated Donors; cyclophosphamide; thymocyte antibody; cyclophosphamide; lymphocyte antibody; acute graft versus host disease; acute lymphoblastic leukemia; adult; allogeneic hematopoietic stem cell transplantation; Article; cancer patient; cancer specific survival; chronic graft versus host disease; comparative effectiveness; controlled study; female; HLA matching; human; immunoprophylaxis; immunosuppressive treatment; incidence; major clinical study; male; matched unrelated donor; medical society; mortality rate; overall survival; Philadelphia chromosome positive cell; retrospective study; survival rate; acute disease; acute lymphoblastic leukemia; acute myeloid leukemia; bone marrow; graft ve

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