Unrelated donor transplantation with posttransplant cyclophosphamide vs ATG for myelodysplastic neoplasms

Author:

Chalandon Yves1ORCID,Eikema Diderik-Jan2,Moiseev Ivan3ORCID,Ciceri Fabio4,Koster Linda5,Vydra Jan6ORCID,Passweg Jakob7,Rovira Montserrat8,Ozcelik Tulay9,Gedde-Dahl Tobias10ORCID,Kröger Nicolaus11ORCID,Potter Victoria12,Yakoub-Agha Ibrahim13ORCID,Rambaldi Alessandro14ORCID,Itälä-Remes Maija15ORCID,Tanase Alina16,Onida Francesco17,Gurnari Carmelo18ORCID,Scheid Christof19ORCID,Drozd-Sokolowska Joanna20,Raj Kavita21ORCID,McLornan Donal P.21,Robin Marie22ORCID

Affiliation:

1. 1Hôpitaux Universitaires de Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland

2. 2EBMT Leiden Statistical Unit, Leiden, The Netherlands

3. 3RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia

4. 4Ospedale San Raffaele s.r.l., Milan, Italy

5. 5EBMT Leiden Study Unit, Leiden, The Netherlands

6. 6Institute of Hematology and Blood Transfusion, Prague, Czech Republic

7. 7University Hospital Basel, Basel, Switzerland

8. 8Bone Marrow Transplantation Unit, Haematology Department, Institute of Haematology and Oncology, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain

9. 9Demiroglu Bilim University Istanbul Florence Nightingale Hospital, Istanbul, Turkey

10. 10Oslo University Hospital, Rikshospitalet Oslo, Oslo, Norway

11. 11University Hospital Eppendorf, Hamburg, Germany

12. 12King’s College Hospital, London, United Kingdom

13. 13CHU de Lille, Univ Lille, INSERM U1286, INFINITE 59000, Lille, France

14. 14Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy

15. 15Turku University Hospital, Turku, Finland

16. 16Fundeni Clinical Institute, Bucharest, Romania

17. 17Hematology and BMT Unit, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy

18. 18Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy

19. 19University of Cologne, Cologne, Germany

20. 20University Clinical Centre, Medical University of Warsaw, Warsaw, Poland

21. 21University College London Hospitals NHS Foundation Trust, London, United Kingdom

22. 22Hôpital Saint-Louis, APHP, Université de Paris Cité, Paris, France

Abstract

Abstract It has been reported in prospective randomized trials that antithymocyte globulin (ATG)–based graft-versus-host disease (GVHD) prophylaxis has benefits in the setting of allogeneic hematopoietic stem cell transplantation (allo-HSCT) with unrelated donors (UDs). However, the optimal GVHD prophylaxis strategy has been challenged recently by the increasing use of posttransplant cyclophosphamide (PTCY). We report from the European Society for Blood and Marrow Transplantation registry the outcomes of 960 patients with myelodysplastic neoplasms who underwent allo-HSCT from UD with PTCY or ATG as GVHD prophylaxis. The primary outcomes were overall survival (OS) and progression-free survival (PFS). The disease characteristics were similar in both groups. Day 28 neutrophil engraftment was significantly better with ATG (93% vs 85%). Over a median follow-up of 4.4 years, the 5-year OS was 58% with PTCY, and 49% in the ATG group. The 5-year PFS was higher for PTCY at 53% vs 44% for ATG. Grade 2 to 4 acute GVHD incidence was lower when PTCY was used (23%), whereas there was no difference in the incidence of chronic GVHD at 5 years. Multivariable analyses confirmed better OS and PFS with PTCY with a hazard ratio (HR) for ATG of 1.32 (1-1.74) and a better PFS for PTCY with a HR for ATG of 1.33. This study suggests that GVHD prophylaxis using PTCY instead of ATG in this setting remains a valid option. Further prospective randomized studies would be essential to confirm these results.

Publisher

American Society of Hematology

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