Post‐transplantation cyclophosphamide versus antithymocyte globulin in patients with acute myeloid leukemia undergoing allogeneic stem cell transplantation from HLA‐identical sibling donors: A retrospective analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

• Published in: Cancer Vol. 127; no. 2; pp. 209 - 218
• Main Authors: Battipaglia, Giorgia, Labopin, Myriam, Hamladji, Rose‐Marie, Blaise, Didier, Chevallier, Patrice, Brissot, Eolia, Gerbitz, Armin, Socié, Gerard, Afanasyev, Boris, Ciceri, Fabio, Meijer, Ellen, Koc, Yener, Cornelissen, Jan J., Huynh, Anne, Ozdogu, Hakan, Maertens, Johan, Paul, Franciane, Labussière‐Wallet, Hélène, Ruggeri, Annalisa, Aljurf, Mahmoud, Bazarbachi, Ali, Savani, Bipin, Nagler, Arnon, Mohty, Mohamad
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.01.2021; Wiley
• Subjects: Acute myeloid leukemia; allogeneic hematopoietic transplantation; Antilymphocyte serum; antithymocyte globulin; Blood; Cyclophosphamide; Donors; Globulins; Graft-versus-host reaction; graft‐versus‐host disease; Hematopoietic stem cells; Histocompatibility antigen HLA; Immunology; Immunosuppressive agents; Leukemia; Life Sciences; Myeloid leukemia; Oncology; Peripheral blood; post‐transplantation cyclophosphamide; Stem cell transplantation; Stem cells; Thymocytes; Transplantation; allogeneic hematopoietic transplantation; post-transplantation cyclophosphamide; acute myeloid leukemia; antithymocyte globulin; graft-versus-host disease
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.33255

BACKGROUND Graft‐versus‐host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Addition of antithymocyte globulin (ATG) or post‐transplantation cyclophosphamide (PTCY) to standard immunosuppressive agents reduces GVHD in different donor settings. METHODS We compared the outcomes of adults with acute myeloid leukemia undergoing allo‐HSCT from HLA‐identical sibling donors after the use of PTCY (n = 197) or ATG (n = 1913). RESULTS Patients in the PTCY group were younger than those in the ATG group (median age, 47 vs 54 years; P < .01). Peripheral blood was the most frequently used stem cell source, being significantly more frequent in the ATG group than in the PTCY group (95% vs 70% P < .01). The conditioning regimen was more frequently myeloablative in the PTCY group than in the ATG group (59% vs 48%; P < .01). Time to neutrophil engraftment was shorter in the ATG group than in the PTCY group (17 vs 20 days; P < .01). No differences were observed according to the other transplantation outcomes, except for chronic GVHD of all grades and extensive chronic GVHD at 2 years, which were significantly lower in the ATG group compared with the PTCY group (P < .02). CONCLUSION PTCY is feasible in an HLA‐identical sibling setting, and despite similar outcomes, ATG may be associated with lower incidence of chronic GVHD. Addition of antithymocyte globulin (ATG) or post‐transplantation cyclophosphamide (PTCY) to standard immunosuppressive agents in patients who received a transplant from an HLA‐identical sibling donor is feasible and allows low rates of graft‐versus‐host disease (GVHD).When compared with PTCY, the use of ATG is associated with lower cumulative incidence of chronic GVHD.