Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant

Annalisa Ruggeri, Y Sun, M Labopin, A Bacigalupo, F Lorentino, William Arcese, S Santarone, Z Gülbas, D Blaise, G Messina, A Ghavamzadeh, F Malard, Benedetto Bruno, JL Diez-Martin, Y Koc, F Ciceri, M Mohty, A Nagler

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Abstract

Severe graft-versus-host disease is a major barrier for non-T-celldepleted haploidentical stem cell transplantation. There is no consensus on the optimal graft-versus-host disease prophylaxis. This study compared the two most commonly used graft-versus-host disease prophylaxis regimens (post-transplant cyclophosphamide-based vs. the anti-thymocyte globulin-based) in adults with acute myeloid leukemia reported to the European Society for Blood and Bone Marrow Transplantation. A total of 308 patients were analyzed; 193 received posttransplant cyclophosphamide-based regimen and 115 anti-thymocyte globulin-based regimen as anti-graft-versus-host disease prophylaxis. The post-transplant cyclophosphamide-based regimen was more likely to be associated to bone marrow as graft source (60% vs. 40%; P=0.01). Patients in the post-transplant cyclophosphamide-based regimen group had significantly less grade 3-4 acute graft-versus-host disease than those in the anti-thymocyte globulin-based group (5% vs. 12%, respectively; P=0.01), comparable to chronic graft-versus-host disease. Multivariate analysis showed that non-relapse mortality was lower in the post-transplant cyclophosphamide-based regimen group [22% vs. 30%, Hazard ratio (HR) 1.77(95%CI: 1.09-2.86); P=0.02] with no difference in relapse incidence. Patients receiving post-transplant cyclophosphamide-based regimen had better graft-versus-host disease-free, relapse-free survival [HR 1.45 (95%CI: 1.04-2.02); P=0.03] and leukemia-free survival [HR 1.48 (95%CI: 1.03-2.12); P=0.03] than those in the anti-thymocyte globulinbased group. In the multivariate analysis, there was also a trend for a higher overall survival [HR 1.43 (95%CI: 0.98-2.09); P=0.06] for post-trans- plant cyclophosphamide-based regimen versus the anti-thymocyte globulin-based group. Notably, center experience was also associated with nonrelapse mortality and graft-versus-host disease-free, relapse-free survival. Haplo-SCT using a post-transplant cyclophosphamide-based regimen can achieve better leukemia-free survival and graft-versus- host disease-free, relapse-free survival, lower incidence of graft-versus-host disease and nonrelapse mortality as compared to anti-thymocyte globulin-based graft-versus-host disease prophylaxis in patients with acute myeloid leukemia. © 2017 Ferrata Storti Foundation.
Original languageEnglish
Pages (from-to)401-410
Number of pages10
JournalHaematologica
Volume102
Issue number2
DOIs
Publication statusPublished - 2017

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Ruggeri, A., Sun, Y., Labopin, M., Bacigalupo, A., Lorentino, F., Arcese, W., Santarone, S., Gülbas, Z., Blaise, D., Messina, G., Ghavamzadeh, A., Malard, F., Bruno, B., Diez-Martin, JL., Koc, Y., Ciceri, F., Mohty, M., & Nagler, A. (2017). Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. Haematologica, 102(2), 401-410. https://doi.org/10.3324/haematol.2016.151779