Impact of Adding Antithymocyte Globulin to Posttransplantation Cyclophosphamide in Haploidentical Stem-Cell Transplantation
Graft-versus-host disease (GVHD) is a major cause of mortality after allogeneic stem-cell transplantation. Posttransplantation cyclophosphamide (PT/CY) has become standard prophylaxis of GVHD in T-replete haploidentical transplantation. The question is whether adding antithymocyte globulin (ATG) to...
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| Veröffentlicht in: | Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2020-09, Vol.20 (9), p.617-623 |
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| creator | El-Cheikh, Jean Devillier, Raynier Dulery, Remy Massoud, Radwan Al Chami, Farouk Ghaoui, Nohra Moukalled, Nour Pagliardini, Thomas Marino, Fabrizio Malard, Florent Bazarbachi, Abdul Hamid Mohty, Razan Bazarbachi, Ali Castagna, Luca Mohty, Mohamad Blaise, Didier |
| description | Graft-versus-host disease (GVHD) is a major cause of mortality after allogeneic stem-cell transplantation. Posttransplantation cyclophosphamide (PT/CY) has become standard prophylaxis of GVHD in T-replete haploidentical transplantation. The question is whether adding antithymocyte globulin (ATG) to PT/CY may further reduce the incidence of GVHD compared to PT/CY only.
We retrospectively studied 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine (TBF) conditioning. Sixty-nine patients (26%) received ATG.
In the ATG group, 3% died due to GVHD versus 8% in the no ATG group. The 100-day and 1-year nonrelapse mortality (NRM) was 0% and 19%, respectively, in the whole cohort. On univariate analysis, the 1-year NRM was 8% versus 23% in patients receiving ATG and no ATG, respectively (P = .005). The no ATG group had a higher incidence of acute GVHD at 12 months compared to the ATG group (22% vs. 12%, respectively, P = .029). The ATG group had better overall survival at 12 months compared to the no ATG group (79% vs. 69%, P = .029). On multivariate analysis, adding ATG to PT/CY had no significant impact on any of the outcomes. A low disease risk index was associated with better overall survival and lower NRM, while Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥ 3 was associated with higher NRM.
ATG can be safely used as part of the pretransplantation conditioning and does not increase the incidence of relapse or complications after transplantation.
We conducted a retrospective analysis of 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine conditioning in order to evaluate the impact of adding antithymocyte globulin (ATG) to posttransplantation cyclophosphamide (PT/CY) on the incidence of graft-versus-host disease and transplantation outcomes. Sixty-nine patients (26%) received ATG while 199 patients (74%) did not receive ATG. ATG can be safely used as part of pretransplantation conditioning. |
| doi_str_mv | 10.1016/j.clml.2020.04.003 |
| format | Article |
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We retrospectively studied 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine (TBF) conditioning. Sixty-nine patients (26%) received ATG.
In the ATG group, 3% died due to GVHD versus 8% in the no ATG group. The 100-day and 1-year nonrelapse mortality (NRM) was 0% and 19%, respectively, in the whole cohort. On univariate analysis, the 1-year NRM was 8% versus 23% in patients receiving ATG and no ATG, respectively (P = .005). The no ATG group had a higher incidence of acute GVHD at 12 months compared to the ATG group (22% vs. 12%, respectively, P = .029). The ATG group had better overall survival at 12 months compared to the no ATG group (79% vs. 69%, P = .029). On multivariate analysis, adding ATG to PT/CY had no significant impact on any of the outcomes. A low disease risk index was associated with better overall survival and lower NRM, while Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥ 3 was associated with higher NRM.
ATG can be safely used as part of the pretransplantation conditioning and does not increase the incidence of relapse or complications after transplantation.
We conducted a retrospective analysis of 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine conditioning in order to evaluate the impact of adding antithymocyte globulin (ATG) to posttransplantation cyclophosphamide (PT/CY) on the incidence of graft-versus-host disease and transplantation outcomes. Sixty-nine patients (26%) received ATG while 199 patients (74%) did not receive ATG. ATG can be safely used as part of pretransplantation conditioning.</description><identifier>ISSN: 2152-2650</identifier><identifier>EISSN: 2152-2669</identifier><identifier>DOI: 10.1016/j.clml.2020.04.003</identifier><identifier>PMID: 32457025</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>ATG ; Cancer ; Conditioning regimen ; Life Sciences ; Overall survival ; Thiotepa–busulfan–fludarabine (TBF) ; Transplantation outcomes</subject><ispartof>Clinical lymphoma, myeloma and leukemia, 2020-09, Vol.20 (9), p.617-623</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-d5f188d00342106408dfb1e7488f319dd0c90a081e2e963b13137997a357f74c3</citedby><cites>FETCH-LOGICAL-c390t-d5f188d00342106408dfb1e7488f319dd0c90a081e2e963b13137997a357f74c3</cites><orcidid>0000-0003-0243-4040 ; 0000-0002-8199-8348 ; 0000-0001-9275-3840 ; 0000-0001-6160-1801 ; 0000-0002-7171-4997 ; 0000-0001-8536-7781 ; 0000-0002-7264-808X ; 0000-0002-5024-1713</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S2152265020301816$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32457025$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://amu.hal.science/hal-03623476$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>El-Cheikh, Jean</creatorcontrib><creatorcontrib>Devillier, Raynier</creatorcontrib><creatorcontrib>Dulery, Remy</creatorcontrib><creatorcontrib>Massoud, Radwan</creatorcontrib><creatorcontrib>Al Chami, Farouk</creatorcontrib><creatorcontrib>Ghaoui, Nohra</creatorcontrib><creatorcontrib>Moukalled, Nour</creatorcontrib><creatorcontrib>Pagliardini, Thomas</creatorcontrib><creatorcontrib>Marino, Fabrizio</creatorcontrib><creatorcontrib>Malard, Florent</creatorcontrib><creatorcontrib>Bazarbachi, Abdul Hamid</creatorcontrib><creatorcontrib>Mohty, Razan</creatorcontrib><creatorcontrib>Bazarbachi, Ali</creatorcontrib><creatorcontrib>Castagna, Luca</creatorcontrib><creatorcontrib>Mohty, Mohamad</creatorcontrib><creatorcontrib>Blaise, Didier</creatorcontrib><title>Impact of Adding Antithymocyte Globulin to Posttransplantation Cyclophosphamide in Haploidentical Stem-Cell Transplantation</title><title>Clinical lymphoma, myeloma and leukemia</title><addtitle>Clin Lymphoma Myeloma Leuk</addtitle><description>Graft-versus-host disease (GVHD) is a major cause of mortality after allogeneic stem-cell transplantation. Posttransplantation cyclophosphamide (PT/CY) has become standard prophylaxis of GVHD in T-replete haploidentical transplantation. The question is whether adding antithymocyte globulin (ATG) to PT/CY may further reduce the incidence of GVHD compared to PT/CY only.
We retrospectively studied 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine (TBF) conditioning. Sixty-nine patients (26%) received ATG.
In the ATG group, 3% died due to GVHD versus 8% in the no ATG group. The 100-day and 1-year nonrelapse mortality (NRM) was 0% and 19%, respectively, in the whole cohort. On univariate analysis, the 1-year NRM was 8% versus 23% in patients receiving ATG and no ATG, respectively (P = .005). The no ATG group had a higher incidence of acute GVHD at 12 months compared to the ATG group (22% vs. 12%, respectively, P = .029). The ATG group had better overall survival at 12 months compared to the no ATG group (79% vs. 69%, P = .029). On multivariate analysis, adding ATG to PT/CY had no significant impact on any of the outcomes. A low disease risk index was associated with better overall survival and lower NRM, while Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥ 3 was associated with higher NRM.
ATG can be safely used as part of the pretransplantation conditioning and does not increase the incidence of relapse or complications after transplantation.
We conducted a retrospective analysis of 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine conditioning in order to evaluate the impact of adding antithymocyte globulin (ATG) to posttransplantation cyclophosphamide (PT/CY) on the incidence of graft-versus-host disease and transplantation outcomes. Sixty-nine patients (26%) received ATG while 199 patients (74%) did not receive ATG. 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Posttransplantation cyclophosphamide (PT/CY) has become standard prophylaxis of GVHD in T-replete haploidentical transplantation. The question is whether adding antithymocyte globulin (ATG) to PT/CY may further reduce the incidence of GVHD compared to PT/CY only.
We retrospectively studied 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine (TBF) conditioning. Sixty-nine patients (26%) received ATG.
In the ATG group, 3% died due to GVHD versus 8% in the no ATG group. The 100-day and 1-year nonrelapse mortality (NRM) was 0% and 19%, respectively, in the whole cohort. On univariate analysis, the 1-year NRM was 8% versus 23% in patients receiving ATG and no ATG, respectively (P = .005). The no ATG group had a higher incidence of acute GVHD at 12 months compared to the ATG group (22% vs. 12%, respectively, P = .029). The ATG group had better overall survival at 12 months compared to the no ATG group (79% vs. 69%, P = .029). On multivariate analysis, adding ATG to PT/CY had no significant impact on any of the outcomes. A low disease risk index was associated with better overall survival and lower NRM, while Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥ 3 was associated with higher NRM.
ATG can be safely used as part of the pretransplantation conditioning and does not increase the incidence of relapse or complications after transplantation.
We conducted a retrospective analysis of 268 patients undergoing myeloablative haploidentical transplantation with thiotepa, busulfan, and fludarabine conditioning in order to evaluate the impact of adding antithymocyte globulin (ATG) to posttransplantation cyclophosphamide (PT/CY) on the incidence of graft-versus-host disease and transplantation outcomes. Sixty-nine patients (26%) received ATG while 199 patients (74%) did not receive ATG. ATG can be safely used as part of pretransplantation conditioning.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32457025</pmid><doi>10.1016/j.clml.2020.04.003</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-0243-4040</orcidid><orcidid>https://orcid.org/0000-0002-8199-8348</orcidid><orcidid>https://orcid.org/0000-0001-9275-3840</orcidid><orcidid>https://orcid.org/0000-0001-6160-1801</orcidid><orcidid>https://orcid.org/0000-0002-7171-4997</orcidid><orcidid>https://orcid.org/0000-0001-8536-7781</orcidid><orcidid>https://orcid.org/0000-0002-7264-808X</orcidid><orcidid>https://orcid.org/0000-0002-5024-1713</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals |
| subjects | ATG Cancer Conditioning regimen Life Sciences Overall survival Thiotepa–busulfan–fludarabine (TBF) Transplantation outcomes |
| title | Impact of Adding Antithymocyte Globulin to Posttransplantation Cyclophosphamide in Haploidentical Stem-Cell Transplantation |
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