Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation

Giorgia Battipaglia; Myriam Labopin; Nicolaus Kröger; Antonin Vitek; Boris Afanasyev; Inken Hilgendorf; Johannes Schetelig; Arnold Ganser; Didier Blaise; Maija Itälä-Remes; Jakob R Passweg; Francesca Bonifazi; Jurgen Finke; Annalisa Ruggeri; Arnon Nagler; Mohamad Mohty

doi:10.1182/blood.2019000487

Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation

Giorgia Battipaglia, Myriam Labopin, Nicolaus Kröger, Antonin Vitek, Boris Afanasyev, Inken Hilgendorf, Johannes Schetelig, Arnold Ganser, Didier Blaise, Maija Itälä-Remes, Jakob R Passweg, Francesca Bonifazi, Jurgen Finke, Annalisa Ruggeri, Arnon Nagler, Mohamad Mohty

Ospedale Pediatrico Bambino Gesu

Research output: Contribution to journal › Article › peer-review

Abstract

The use of anti-thymocyte globulin (ATG) has represented the standard of care in graft-versus-host disease (GVHD) prophylaxis in patients undergoing a mismatched unrelated donor (MMUD) transplant. The safety and feasibility of posttransplant cyclophosphamide (PTCY) in this setting have been reported recently, but no study has compared the outcomes of PTCY vs ATG in 9/10 MMUD transplants. Using the registry data of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we performed a matched-pair analysis comparing those 2 strategies in a 9/10 MMUD setting. Ninety-three patients receiving PTCY were matched with 179 patients receiving ATG. A significantly lower incidence of severe acute GVHD was observed with PTCY compared with ATG. Recipients of the former also showed higher leukemia-free survival and GVHD/relapse-free survival (GRFS). When performing a subgroup analysis including patients receiving peripheral blood stem cells, being in complete remission, or receiving the same associated immunosuppressive agents, superiority of PTCY over ATG was confirmed. Similar to the haploidentical setting, use of PTCY is an effective anti-GVHD prophylaxis in the 9/10 MMUD transplant. Use of PTCY may also provide better outcomes in long-term disease control. These results need confirmation in large prospective randomized trials.

Original language	English
Pages (from-to)	892-899
Number of pages	8
Journal	Blood
Volume	134
Issue number	11
DOIs	https://doi.org/10.1182/blood.2019000487
Publication status	Published - Sept 12 2019

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Battipaglia, G., Labopin, M., Kröger, N., Vitek, A., Afanasyev, B., Hilgendorf, I., Schetelig, J., Ganser, A., Blaise, D., Itälä-Remes, M., Passweg, J. R., Bonifazi, F., Finke, J., Ruggeri, A., Nagler, A., & Mohty, M. (2019). Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation. Blood, 134(11), 892-899. https://doi.org/10.1182/blood.2019000487

Battipaglia, G, Labopin, M, Kröger, N, Vitek, A, Afanasyev, B, Hilgendorf, I, Schetelig, J, Ganser, A, Blaise, D, Itälä-Remes, M, Passweg, JR, Bonifazi, F, Finke, J, Ruggeri, A, Nagler, A & Mohty, M 2019, 'Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation', Blood, vol. 134, no. 11, pp. 892-899. https://doi.org/10.1182/blood.2019000487

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title = "Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation",

abstract = "The use of anti-thymocyte globulin (ATG) has represented the standard of care in graft-versus-host disease (GVHD) prophylaxis in patients undergoing a mismatched unrelated donor (MMUD) transplant. The safety and feasibility of posttransplant cyclophosphamide (PTCY) in this setting have been reported recently, but no study has compared the outcomes of PTCY vs ATG in 9/10 MMUD transplants. Using the registry data of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we performed a matched-pair analysis comparing those 2 strategies in a 9/10 MMUD setting. Ninety-three patients receiving PTCY were matched with 179 patients receiving ATG. A significantly lower incidence of severe acute GVHD was observed with PTCY compared with ATG. Recipients of the former also showed higher leukemia-free survival and GVHD/relapse-free survival (GRFS). When performing a subgroup analysis including patients receiving peripheral blood stem cells, being in complete remission, or receiving the same associated immunosuppressive agents, superiority of PTCY over ATG was confirmed. Similar to the haploidentical setting, use of PTCY is an effective anti-GVHD prophylaxis in the 9/10 MMUD transplant. Use of PTCY may also provide better outcomes in long-term disease control. These results need confirmation in large prospective randomized trials.",

author = "Giorgia Battipaglia and Myriam Labopin and Nicolaus Kr{\"o}ger and Antonin Vitek and Boris Afanasyev and Inken Hilgendorf and Johannes Schetelig and Arnold Ganser and Didier Blaise and Maija It{\"a}l{\"a}-Remes and Passweg, {Jakob R} and Francesca Bonifazi and Jurgen Finke and Annalisa Ruggeri and Arnon Nagler and Mohamad Mohty",

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AU - Battipaglia, Giorgia

AU - Labopin, Myriam

AU - Kröger, Nicolaus

AU - Vitek, Antonin

AU - Afanasyev, Boris

AU - Hilgendorf, Inken

AU - Schetelig, Johannes

AU - Ganser, Arnold

AU - Blaise, Didier

AU - Itälä-Remes, Maija

AU - Passweg, Jakob R

AU - Bonifazi, Francesca

AU - Finke, Jurgen

AU - Ruggeri, Annalisa

AU - Nagler, Arnon

AU - Mohty, Mohamad

PY - 2019/9/12

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N2 - The use of anti-thymocyte globulin (ATG) has represented the standard of care in graft-versus-host disease (GVHD) prophylaxis in patients undergoing a mismatched unrelated donor (MMUD) transplant. The safety and feasibility of posttransplant cyclophosphamide (PTCY) in this setting have been reported recently, but no study has compared the outcomes of PTCY vs ATG in 9/10 MMUD transplants. Using the registry data of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we performed a matched-pair analysis comparing those 2 strategies in a 9/10 MMUD setting. Ninety-three patients receiving PTCY were matched with 179 patients receiving ATG. A significantly lower incidence of severe acute GVHD was observed with PTCY compared with ATG. Recipients of the former also showed higher leukemia-free survival and GVHD/relapse-free survival (GRFS). When performing a subgroup analysis including patients receiving peripheral blood stem cells, being in complete remission, or receiving the same associated immunosuppressive agents, superiority of PTCY over ATG was confirmed. Similar to the haploidentical setting, use of PTCY is an effective anti-GVHD prophylaxis in the 9/10 MMUD transplant. Use of PTCY may also provide better outcomes in long-term disease control. These results need confirmation in large prospective randomized trials.

AB - The use of anti-thymocyte globulin (ATG) has represented the standard of care in graft-versus-host disease (GVHD) prophylaxis in patients undergoing a mismatched unrelated donor (MMUD) transplant. The safety and feasibility of posttransplant cyclophosphamide (PTCY) in this setting have been reported recently, but no study has compared the outcomes of PTCY vs ATG in 9/10 MMUD transplants. Using the registry data of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we performed a matched-pair analysis comparing those 2 strategies in a 9/10 MMUD setting. Ninety-three patients receiving PTCY were matched with 179 patients receiving ATG. A significantly lower incidence of severe acute GVHD was observed with PTCY compared with ATG. Recipients of the former also showed higher leukemia-free survival and GVHD/relapse-free survival (GRFS). When performing a subgroup analysis including patients receiving peripheral blood stem cells, being in complete remission, or receiving the same associated immunosuppressive agents, superiority of PTCY over ATG was confirmed. Similar to the haploidentical setting, use of PTCY is an effective anti-GVHD prophylaxis in the 9/10 MMUD transplant. Use of PTCY may also provide better outcomes in long-term disease control. These results need confirmation in large prospective randomized trials.

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DO - 10.1182/blood.2019000487

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JO - Blood

JF - Blood

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ER -

Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation

Abstract

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