Antithymocyte globulins and chronic graft-vs-host disease after myeloablative allogeneic stem cell transplantation from HLA-matched unrelated donors: a report from the Sociéte Française de Greffe de Moelle et de Thérapie Cellulaire

• Published in: Leukemia Vol. 24; no. 11; pp. 1867 - 1874
• Main Authors: Mohty, M, Labopin, M, Balère, M L, Socié, G, Milpied, N, Tabrizi, R, Ifrah, N, Hicheri, Y, Dhedin, N, Michallet, M, Buzyn, A, Cahn, J-Y, Bourhis, J-H, Blaise, D, Raffoux, C, Espérou, H, Yakoub-Agha, I
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-11-2010; Nature Publishing Group; Springer Nature
• Subjects: 692/699/249/1529; 692/699/67/1990/283; 692/700/565/251; 692/700/565/545/576/1955; Adolescent; Adult; Aged; Analysis; Animals; Antigens; Antilymphocyte Serum; Antilymphocyte Serum - therapeutic use; Antithymocyte globulin; Biological and medical sciences; Cancer; Cancer Research; Care and treatment; Critical Care Medicine; Disease prevention; Donors; Female; Globulins; Graft versus host disease; Graft versus host reaction; Graft vs Host Disease; Graft vs Host Disease - epidemiology; Graft vs Host Disease - etiology; Graft vs Host Disease - prevention & control; Health aspects; Hematologic and hematopoietic diseases; Hematology; Histocompatibility antigen HLA; Histocompatibility antigens; Histocompatibility Testing; HLA Antigens; HLA Antigens - immunology; HLA histocompatibility antigens; Humans; Incidence; Intensive; Internal Medicine; Leukemia; Leukemia, Myeloid, Acute; Leukemia, Myeloid, Acute - immunology; Leukemia, Myeloid, Acute - surgery; Leukocytes; Life Sciences; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Mud; Multivariate analysis; Myelodysplastic Syndromes; Myelodysplastic Syndromes - immunology; Myelodysplastic Syndromes - surgery; Oncology; original-article; Patient outcomes; Physiological aspects; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma - immunology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - surgery; Prophylaxis; Rabbits; Retrospective Studies; Stem Cell Transplantation; Stem Cell Transplantation - adverse effects; Stem Cell Transplantation - methods; Stem cells; Thymocytes; Tissue Donors; Transplantation; Transplantation, Homologous; Transplantation, Homologous - methods; Treatment Outcome; France; Paris France; unrelated donors; GVHD; allogeneic stem cell transplantation; ATG; Immunopathology; Graft versus host disease; HLA-System; Hematology; Unrelated donor; Chronic disease; Stem cell; Major histocompatibility system; Hematopoietic cell; Homograft; Treatment; Immunotherapy; Graft; Myelosuppression; Antithymocyte globulin; Histocompatibility
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/leu.2010.200

This retrospective report assessed the impact of rabbit antithymocyte globulins (ATG), incorporated within a standard myeloablative conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT) using human leukocyte antigen-matched unrelated donors (HLA-MUD), on the incidence of acute and chronic graft-vs-host disease (GVHD). In this series of leukemia patients, 120 patients (70%) did not receive ATG (‘no-ATG’ group), whereas 51 patients received ATG (‘ATG’ group). With a median follow-up of 30.3 months, the cumulative incidence of grade 3–4 acute GVHD was 36% in the no-ATG group and 20% in the ATG group (
P
=0.11). The cumulative incidence of extensive chronic GVHD was significantly lower in the ATG group as compared to the no-ATG group (4 vs 32%, respectively;
P
=0.0017). In multivariate analysis, the absence of use of ATG was the strongest parameter associated with an increased risk of extensive chronic GVHD (relative risk)=7.14, 95% CI: 1.7–33.3,
P
=0.008). At 2 years, the probability of nonrelapse mortality, relapse, overall and leukemia-free survivals was not significantly different between the no-ATG and ATG groups. We conclude that the addition of ATG to GVHD prophylaxis resulted in decreased incidence of extensive chronic GVHD without an increase in relapse or nonrelapse mortality, and without compromising survival after myeloablative allo-SCT from HLA-MUD.