Post-transplantation cyclophosphamide versus antithymocyte globulin in patients with acute myeloid leukemia undergoing allogeneic stem cell transplantation from HLA-identical sibling donors: A retrospective analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation
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John Wiley and Sons Inc
Abstract
BACKGROUND: Graft-versus-host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Addition of antithymocyte globulin (ATG) or post-transplantation cyclophosphamide (PTCY) to standard immunosuppressive agents reduces GVHD in different donor settings. METHODS: We compared the outcomes of adults with acute myeloid leukemia undergoing allo-HSCT from HLA-identical sibling donors after the use of PTCY (n = 197) or ATG (n = 1913). RESULTS: Patients in the PTCY group were younger than those in the ATG group (median age, 47 vs 54 years; P <.01). Peripheral blood was the most frequently used stem cell source, being significantly more frequent in the ATG group than in the PTCY group (95% vs 70% P <.01). The conditioning regimen was more frequently myeloablative in the PTCY group than in the ATG group (59% vs 48%; P <.01). Time to neutrophil engraftment was shorter in the ATG group than in the PTCY group (17 vs 20 days; P <.01). No differences were observed according to the other transplantation outcomes, except for chronic GVHD of all grades and extensive chronic GVHD at 2 years, which were significantly lower in the ATG group compared with the PTCY group (P <.02). CONCLUSION: PTCY is feasible in an HLA-identical sibling setting, and despite similar outcomes, ATG may be associated with lower incidence of chronic GVHD. © 2020 American Cancer Society
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Acute myeloid leukemia, Allogeneic hematopoietic transplantation, Antithymocyte globulin, Graft-versus-host disease, Post-transplantation cyclophosphamide, Adolescent, Adult, Aged, Antilymphocyte serum, Blood donors, Cyclophosphamide, Feasibility studies, Female, Follow-up studies, Graft vs host disease, Hematopoietic stem cell transplantation, Hla antigens, Humans, Immunosuppressive agents, Incidence, Leukemia, myeloid, acute, Male, Middle aged, Retrospective studies, Siblings, Transplantation, homologous, Treatment outcome, Young adult, Cyclosporine, Methotrexate, Mycophenolate mofetil, Tacrolimus, Thymocyte antibody, Hla antigen, Immunosuppressive agent, Lymphocyte antibody, Age distribution, Allogeneic hematopoietic stem cell transplantation, Article, Cancer specific survival, Chronic graft versus host disease, Controlled study, Engraftment, Feasibility study, Gvhd relapse free survival, Hla matching, Human, Human cell, Immunosuppressive treatment, Major clinical study, Matched sibling donor, Medical society, Myeloablative conditioning, Outcome assessment, Overall survival, Peripheral blood stem cell, Priority journal, Reduced intensity conditioning, Retrospective study, Risk reduction, Survival, Treatment response, Adverse event, Allotransplantation, Blood donor, Comparative study, Follow up, Graft versus host reaction, Immunology, Procedures, Sibling