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Impact of Thymoglobulin by Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors: A Report From the Société Française de Greffe de Moelle et de Thérapie Cellulaire.
Transplantation. 2016 Aug; 100(8):1732-9.T

Abstract

BACKGROUND

The impact of antithymocyte globulin (ATG) in the setting of a myeloablative conditioning transplantation remains controversial, especially when using bone marrow (BM) as the stem cell source.

METHODS

We therefore conducted a retrospective analysis to investigate the impact of ATG in patients with acute myeloid leukemia or myelodysplastic syndrome receiving myeloablative conditioning followed by a matched 10 of 10 unrelated donor transplant from BM or peripheral blood stem cells (PBSCs). Our study included 356 patients conditioned with cyclophosphamide associated with fractionated total body irradiation or busulfan.

RESULTS

Median follow-up was 17.6 months (range, 0-156). The ATG and PBSCs were the only variables that independently decreased the cumulative incidence (CI) of chronic graft-versus-host disease (GvHD) (hazards ratio [HR], 0.4; 95% CI, 0.21-0.73; P < 0.01; and HR, 0.53; 95% CI, 0.30-0.90; P = 0.02, respectively). The ATG had no impact on overall survival, disease-free survival, relapse, and nonrelapse mortality. In the PBSC group (n = 139), ATG was associated with a lower CI of both grades III to IV acute GvHD (HR, 0.17; 95% CI, 0.03-0.91; P = 0.04), chronic GvHD (HR, 0.31; 95% CI, 0.11-0.87; P = 0.03), and GvHD-free/relapse-free survival (HR, 0.48; 95% CI, 0.29-0.80; P < 0.01), whereas these correlations were not significant in the group of patients (n = 217) receiving BM (HR, 0.36; 95% CI, 0.11-1.93; P = 0.06 for grade III-IV acute GvHD; HR, 0.49; 95% CI, 0.22-1.06; P = 0.08 for chronic GvHD; and HR, 0.69; 95% CI, 0.46-1.01; P = 0.06 for GvHD-free/relapse-free survival).

CONCLUSIONS

Although our results confirm the recommendation for ATG to be added after PBSC transplantation, no obvious benefit was identified using this approach in the setting of BM transplantation. Only prospective studies may yield definitive answers to this question.

Authors+Show Affiliations

1 Service d'hématologie Clinique Adulte et de Thérapie Cellulaire, CHU Estaing, Clermont Ferrand, France.2 Clermont Université, Université d'Auvergne, Clermont Ferrand, France.3 Hematologie/Transplantation, Hôpital St Louis, Paris, France.4 University Hospital and University of Bordeaux, Bordeaux, France.5 CHRU de Lille, France.6 Service d'Hématologie Goupe hospitalier Pitié-Salpétrière, Paris, France.7 Hopital Edouard Herriot, Lyon, France.8 Service d'hématologie, Centre Henri Becquerel, Rouen, France.9 Service d'oncologie Hématologique et Thérapie Cellulaire, CHU de Poitiers, Poitiers, France.10 Hopital Saint-Antoine, APHP, Paris, France.11 Université Pierre & Marie Curie, Paris, France.12 INSERM, Paris, France.13 Hôpital Necker, Paris, France.14 Hôpital Purpan CHU Toulouse, France.15 Department of Clinical Hematology, Rennes University Hospital, Rennes, F-35043, France.16 INSERM UMR 917, Rennes1 University, Rennes, France.17 Department of Hematology, University Hospital, Grenoble, France.18 CHU de Nice, Nice, France.19 Department of Hematology, AP-HP, Henri Mondor Hospital, France.20 University Paris Est Créteil (UPEC) Center for Clinical Investigation in Biotherapy, Créteil, France.21 CHU Hotel Dieu Nantes, France.22 CHU Caen, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26528768

Citation

Ravinet, Aurelie, et al. "Impact of Thymoglobulin By Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors: a Report From the Société Française De Greffe De Moelle Et De Thérapie Cellulaire." Transplantation, vol. 100, no. 8, 2016, pp. 1732-9.
Ravinet A, Cabrespine A, Socié G, et al. Impact of Thymoglobulin by Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors: A Report From the Société Française de Greffe de Moelle et de Thérapie Cellulaire. Transplantation. 2016;100(8):1732-9.
Ravinet, A., Cabrespine, A., Socié, G., Milpied, N., Yakoub Agha, I., Nguyen, S., Michallet, M., Menard, A. L., Maillard, N., Mohty, M., Suarez, F., Huynh, A., Marchand, T., Deteix, C., Cassuto, J. P., Maury, S., Chevallier, P., Reman, O., Peffault de Latour, R., & Bay, J. O. (2016). Impact of Thymoglobulin by Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors: A Report From the Société Française de Greffe de Moelle et de Thérapie Cellulaire. Transplantation, 100(8), 1732-9. https://doi.org/10.1097/TP.0000000000000976
Ravinet A, et al. Impact of Thymoglobulin By Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors: a Report From the Société Française De Greffe De Moelle Et De Thérapie Cellulaire. Transplantation. 2016;100(8):1732-9. PubMed PMID: 26528768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of Thymoglobulin by Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors: A Report From the Société Française de Greffe de Moelle et de Thérapie Cellulaire. AU - Ravinet,Aurelie, AU - Cabrespine,Aurelie, AU - Socié,Gerard, AU - Milpied,Noël, AU - Yakoub Agha,Ibrahim, AU - Nguyen,Stephanie, AU - Michallet,Mauricette, AU - Menard,Anne Lise, AU - Maillard,Natacha, AU - Mohty,Mohamad, AU - Suarez,Felipe, AU - Huynh,Anne, AU - Marchand,Tony, AU - Deteix,Clémence, AU - Cassuto,Jill Patrice, AU - Maury,Sebastien, AU - Chevallier,Patrice, AU - Reman,Oumedaly, AU - Peffault de Latour,Régis, AU - Bay,Jacques Olivier, PY - 2015/11/4/entrez PY - 2015/11/4/pubmed PY - 2017/5/30/medline SP - 1732 EP - 9 JF - Transplantation JO - Transplantation VL - 100 IS - 8 N2 - BACKGROUND: The impact of antithymocyte globulin (ATG) in the setting of a myeloablative conditioning transplantation remains controversial, especially when using bone marrow (BM) as the stem cell source. METHODS: We therefore conducted a retrospective analysis to investigate the impact of ATG in patients with acute myeloid leukemia or myelodysplastic syndrome receiving myeloablative conditioning followed by a matched 10 of 10 unrelated donor transplant from BM or peripheral blood stem cells (PBSCs). Our study included 356 patients conditioned with cyclophosphamide associated with fractionated total body irradiation or busulfan. RESULTS: Median follow-up was 17.6 months (range, 0-156). The ATG and PBSCs were the only variables that independently decreased the cumulative incidence (CI) of chronic graft-versus-host disease (GvHD) (hazards ratio [HR], 0.4; 95% CI, 0.21-0.73; P < 0.01; and HR, 0.53; 95% CI, 0.30-0.90; P = 0.02, respectively). The ATG had no impact on overall survival, disease-free survival, relapse, and nonrelapse mortality. In the PBSC group (n = 139), ATG was associated with a lower CI of both grades III to IV acute GvHD (HR, 0.17; 95% CI, 0.03-0.91; P = 0.04), chronic GvHD (HR, 0.31; 95% CI, 0.11-0.87; P = 0.03), and GvHD-free/relapse-free survival (HR, 0.48; 95% CI, 0.29-0.80; P < 0.01), whereas these correlations were not significant in the group of patients (n = 217) receiving BM (HR, 0.36; 95% CI, 0.11-1.93; P = 0.06 for grade III-IV acute GvHD; HR, 0.49; 95% CI, 0.22-1.06; P = 0.08 for chronic GvHD; and HR, 0.69; 95% CI, 0.46-1.01; P = 0.06 for GvHD-free/relapse-free survival). CONCLUSIONS: Although our results confirm the recommendation for ATG to be added after PBSC transplantation, no obvious benefit was identified using this approach in the setting of BM transplantation. Only prospective studies may yield definitive answers to this question. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/26528768/Impact_of_Thymoglobulin_by_Stem_Cell_Source__Peripheral_Blood_Stem_Cell_or_Bone_Marrow__After_Myeloablative_Stem_Cell_Transplantation_From_HLA_10/10_Matched_Unrelated_Donors:_A_Report_From_the_Société_Française_de_Greffe_de_Moelle_et_de_Thérapie_Cellulaire_ L2 - http://dx.doi.org/10.1097/TP.0000000000000976 DB - PRIME DP - Unbound Medicine ER -