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Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia.
Haematologica. 2020 Apr 30 [Online ahead of print]H

Abstract

Graft-versus-host disease (GVHD) prophylaxis for unmanipulated haploidentical hematopoietic cell transplantation (haplo-HCT) include post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG). Utilizing EBMT registry, we compared ATG versus PTCy based GVHD prophylaxis in adult acute lymphoblastic leukemia (ALL) patients undergoing haplo-HCT. Included were 434 patients; ATG (n=98) and PTCy (n=336). Median follow-up was ~2 years. Baseline characteristics were similar between the groups except that the ATG-group was more likely to have relapsed/refractory ALL (P=0.008), non-TBI conditioning (P<0.001), peripheral blood graft source (P=<0.001) and transplanted at an earlier time-period (median year of HCT 2011 vs. 2015). The 100-day grade II-IV and III-IV acute-GVHD was similar between ATG and PTCy, as was 2-year chronic-GVHD. On multivariate analysis (MVA), leukemia-free survival (LFS) and overall survival (OS) was better with PTCy compared to ATG prophylaxis. Relapse incidence (RI) was lower in the PTCy group (P=0.03), while non-relapse mortality (NRM) was not different. Advanced disease and lower performance score were associated with poorer LFS and OS and advanced disease with inferior GVHD-free/relapse-free survival (GRFS). Peripheral grafts were associated with higher GVHD compared to bone marrow grafts. In ALL patients undergoing unmanipulated haplo-HCT, PTCy for GVHD prevention resulted in lower RI and improved LFS and OS compared to ATG.

Authors+Show Affiliations

Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel.West Virginia University, Morgantown, WV, USA; askanate@hsc.wvu.edu.Haematology and EBMT Paris study office / CEREST-TC, Saint Antoine Hospital, Paris, France.Ospedale San Raffaele s.r.l., Milano, Italy.Ospedale San Martino, Department of Haematology II, Genova, Italy.Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey.Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey.Tor Vergata University of Rome, Stem Cell Transplant Unit, Rome, Italy.Klinikum Grosshadern, Med. Klinik III, Munich, Germany.Ospedale San Gerardo, Clinica Ematologica dell`Universita Milano-Biocca, Monza, Italy.Baskent University Hospital, Haematology Division, BMT Unit, Adana, Turkey.First State Pavlov Medical University of St. Petersburg, Russia.First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, China.Florence Nightingale Sisli Hospital, Hematopoietic SCT Unit, Istanbul, Turkey.University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia.Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland.Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.Saint Antoine Hospital and Université Pierre et Marie Curie, Paris, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32354866

Citation

Nagler, Arnon, et al. "Post-transplant Cyclophosphamide Versus Anti-thymocyte Globulin for Graft-versus-host Disease Prevention in Haploidentical Transplantation for Adult Acute Lymphoblastic Leukemia." Haematologica, 2020.
Nagler A, Kanate AS, Labopin M, et al. Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia. Haematologica. 2020.
Nagler, A., Kanate, A. S., Labopin, M., Ciceri, F., Angelucci, E., Koc, Y., Gülbas, Z., Arcese, W., Tischer, J., Pioltelli, P., Ozdogu, H., Afanasyev, B., Wu, D., Arat, M., Peric, Z., Giebel, S., Savani, B., & Mohty, M. (2020). Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia. Haematologica. https://doi.org/10.3324/haematol.2020.247296
Nagler A, et al. Post-transplant Cyclophosphamide Versus Anti-thymocyte Globulin for Graft-versus-host Disease Prevention in Haploidentical Transplantation for Adult Acute Lymphoblastic Leukemia. Haematologica. 2020 Apr 30; PubMed PMID: 32354866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia. AU - Nagler,Arnon, AU - Kanate,Abraham S, AU - Labopin,Myriam, AU - Ciceri,Fabio, AU - Angelucci,Emanuele, AU - Koc,Yener, AU - Gülbas,Zafer, AU - Arcese,William, AU - Tischer,Johanna, AU - Pioltelli,Pietro, AU - Ozdogu,Hakan, AU - Afanasyev,Boris, AU - Wu,Depei, AU - Arat,Mutlu, AU - Peric,Zinaida, AU - Giebel,Sebastian, AU - Savani,Bipin, AU - Mohty,Mohamad, Y1 - 2020/04/30/ PY - 2020/01/12/received PY - 2020/04/28/accepted PY - 2020/5/2/entrez KW - Adult Acute Lymphoblastic Leukemia KW - Graft-versus-Host-Disease KW - Stem Cell Transplantation JF - Haematologica JO - Haematologica N2 - Graft-versus-host disease (GVHD) prophylaxis for unmanipulated haploidentical hematopoietic cell transplantation (haplo-HCT) include post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG). Utilizing EBMT registry, we compared ATG versus PTCy based GVHD prophylaxis in adult acute lymphoblastic leukemia (ALL) patients undergoing haplo-HCT. Included were 434 patients; ATG (n=98) and PTCy (n=336). Median follow-up was ~2 years. Baseline characteristics were similar between the groups except that the ATG-group was more likely to have relapsed/refractory ALL (P=0.008), non-TBI conditioning (P<0.001), peripheral blood graft source (P=<0.001) and transplanted at an earlier time-period (median year of HCT 2011 vs. 2015). The 100-day grade II-IV and III-IV acute-GVHD was similar between ATG and PTCy, as was 2-year chronic-GVHD. On multivariate analysis (MVA), leukemia-free survival (LFS) and overall survival (OS) was better with PTCy compared to ATG prophylaxis. Relapse incidence (RI) was lower in the PTCy group (P=0.03), while non-relapse mortality (NRM) was not different. Advanced disease and lower performance score were associated with poorer LFS and OS and advanced disease with inferior GVHD-free/relapse-free survival (GRFS). Peripheral grafts were associated with higher GVHD compared to bone marrow grafts. In ALL patients undergoing unmanipulated haplo-HCT, PTCy for GVHD prevention resulted in lower RI and improved LFS and OS compared to ATG. SN - 1592-8721 UR - https://www.unboundmedicine.com/medline/citation/32354866/Post-transplant_cyclophosphamide_versus_anti-thymocyte_globulin_for_graft-versus-host_disease_prevention_in_haploidentical_transplantation_for_adult_acute_lymphoblastic_leukemia L2 - http://www.haematologica.org/cgi/pmidlookup?view=long&amp;pmid=32354866 DB - PRIME DP - Unbound Medicine ER -
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