TY - JOUR T1 - Impact of in vivo T cell depletion in HLA-identical allogeneic stem cell transplantation for acute myeloid leukemia in first complete remission conditioned with a fludarabine iv-busulfan myeloablative regimen: a report from the EBMT Acute Leukemia Working Party. AU - Rubio,Marie Thérèse, AU - D'Aveni-Piney,Maud, AU - Labopin,Myriam, AU - Hamladji,Rose-Marie, AU - Sanz,Miguel A, AU - Blaise,Didier, AU - Ozdogu,Hakan, AU - Daguindeau,Etienne, AU - Richard,Carlos, AU - Santarone,Stella, AU - Irrera,Giuseppe, AU - Yakoub-Agha,Ibrahim, AU - Yeshurun,Moshe, AU - Diez-Martin,Jose L, AU - Mohty,Mohamad, AU - Savani,Bipin N, AU - Nagler,Arnon, Y1 - 2017/01/24/ PY - 2016/10/04/received PY - 2016/12/31/accepted PY - 2017/1/26/entrez PY - 2017/1/26/pubmed PY - 2017/11/29/medline KW - Acute myeloid leukemia KW - Allogeneic stem cell transplantation KW - GRFS KW - Graft-versus-host disease KW - HLA-matched related donor KW - In vivo T cell depletion KW - Relapse incidence SP - 31 EP - 31 JF - Journal of hematology & oncology JO - J Hematol Oncol VL - 10 IS - 1 N2 - BACKGROUND: The impact of the use of anti-thymocyte globulin (ATG) in allogeneic stem cell transplantation performed with HLA-identical sibling donors following fludarabine and 4 days intravenous busulfan myeloablative conditioning regimen has been poorly explored. METHODS: We retrospectively analyzed 566 patients who underwent a first HLA-identical allogeneic stem cell transplantation with this conditioning regimen for acute myeloid leukemia in first complete remission between 2006 and 2013 and compared the outcomes of 145 (25.6%) patients who received ATG (ATG group) to 421 (74.4%) who did not (no-ATG group). The Kaplan-Meier estimator, the cumulative incidence function, and Cox proportional hazards regression models were used where appropriate. RESULTS: Patients in the ATG group were older, received more frequently peripheral blood stem cell grafts from older donors, and were transplanted more recently. With a median follow-up of 19 months, patients in the ATG group had reduced 2-year cumulative incidence of chronic graft-versus-host disease (GVHD) (31 vs. 52%, p = 0.0002) and of its extensive form (8 vs. 26%, p < 0.0001) but similar relapse incidence (22 vs. 27%, p = 0.23) leading to improved GVHD and relapse-free survival (GRFS) (60 vs. 40%, p = 0.0001). In multivariate analyses, the addition of ATG was independently associated with lower chronic GVHD (HR = 0.46, p = 0.0001), improved leukemia-free survival (HR = 0.67, p = 0.027), overall survival (HR = 0.65, p = 0.027), and GRFS (HR = 0.51, p = 4 × 10-5). Recipient age above 50 years was the only other factor associated with worse survivals. CONCLUSIONS: These results suggest that the use of ATG with fludarabine and 4 days intravenous busulfan followed by HLA-identical sibling donor allogeneic stem cell transplantation for acute myeloid leukemia improves overall transplant outcomes due to reduced incidence of chronic GVHD without increased relapse risk. SN - 1756-8722 UR - https://www.unboundmedicine.com/medline/citation/28118857/Impact_of_in_vivo_T_cell_depletion_in_HLA_identical_allogeneic_stem_cell_transplantation_for_acute_myeloid_leukemia_in_first_complete_remission_conditioned_with_a_fludarabine_iv_busulfan_myeloablative_regimen:_a_report_from_the_EBMT_Acute_Leukemia_Working_Party_ L2 - https://jhoonline.biomedcentral.com/articles/10.1186/s13045-016-0389-4 DB - PRIME DP - Unbound Medicine ER -