Real-World Impact of Routine Addition of Antithymocyte Globulin to Standard GVHD Prophylaxis in Myeloablative Unrelated Donor Transplants: Important Gains in Graft-versus-Host Disease Prevention though No Difference in Overall Survival.

IF 1.7 4区医学 Q3 HEMATOLOGY

Acta Haematologica Pub Date : 2024-08-28 DOI:10.1159/000541071

Ni Bai, Wasithep Limvorapitak, Robert Henderson, Yasser Abou Mourad, Shanee Chung, Donna Forrest, Kevin Hay, Florian Kuchenbauer, Stephen Nantel, Sujaatha Narayanan, Thomas Nevill, Maryse Power, Judith Rodrigo, Claudie Roy, David Sanford, Kevin Song, Ryan Stubbins, Heather Sutherland, Cynthia Toze, Jennifer White

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引用次数: 0

Abstract

Introduction: Antithymocyte globulin (ATG) has been demonstrated to reduce the incidence of graft-versus-host disease (GVHD); however, it remains controversial whether these gains are offset by an increase in relapse.

Methods: We conducted a retrospective historical control study consisting of patients (n = 210) who underwent myeloablative allogeneic hematopoietic stem-cell transplantation (HSCT) from 2014 to 2020.

Results: The incidence of acute GVHD was lower in the ATG group (51.4%) than the non-ATG group (control) (70.0%, p = 0.010). The incidence of chronic GVHD was also lower in the ATG group at 1-year (36.4% vs. 62.9%, p < 0.001) and 2-year (40.0% vs. 65.7%, p < 0.001) post-HSCT. The mortality due to GVHD was higher in the control (18.5%) than the ATG group (4.3%; p = 0.024). The severe GVHD-relapse-free survival was higher in the ATG group (36.4%) than the control (12.9%; p < 0.001). Nevertheless, the 2-year overall survival was similar.

Conclusion: Our results confirm the effectiveness of ATG in prevention of GVHD in the real-world setting and enhanced GVHD-free survival. An important result is the equalization of overall survival between the ATG and control groups at 1- and 2-year post-HSCT and implies that earlier GVHD-associated mortality may be offset by later relapse mortality producing similar overall survival over time.

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在髓鞘脱落非血缘关系供体移植手术中，在标准预防 GVHD 的基础上常规添加抗胸腺细胞球蛋白的实际影响：虽然总体存活率没有差异，但在预防移植物抗宿主疾病方面取得了重要成果。

导言：抗胸腺细胞球蛋白（ATG）已被证明可降低移植物抗宿主疾病（GVHD）的发病率；然而，这些益处是否会被复发率的增加所抵消仍存在争议：我们进行了一项回顾性历史对照研究，研究对象包括2014年至2020年接受髓溶性异基因造血干细胞移植（HSCT）的患者（n=210）：ATG组急性GVHD发生率（51.4%）低于非ATG组（对照组）（70.0%，P=0.010）。HSCT后1年（36.4% vs. 62.9%，p <0.001）和2年（40.0% vs. 65.7%，p <0.001），ATG组的慢性GVHD发生率也较低。对照组因GVHD导致的死亡率（18.5%）高于ATG组（4.3%；P= 0.024）。ATG 组的严重 GVHD 无复发生存率（36.4%）高于对照组（12.9%；p <0.001）。结论：我们的研究结果证实了ATG治疗的有效性：我们的研究结果证实，ATG在现实世界中有效预防了GVHD，并提高了无GVHD生存率。一个重要的结果是，ATG组和对照组在HSCT后1年和2年的总生存率相同，这意味着早期的GVHD相关死亡率可能会被后期的复发死亡率所抵消，从而在一段时间内产生相似的总生存率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Haematologica 医学-血液学

CiteScore

4.90

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： ''Acta Haematologica'' is a well-established and internationally recognized clinically-oriented journal featuring balanced, wide-ranging coverage of current hematology research. A wealth of information on such problems as anemia, leukemia, lymphoma, multiple myeloma, hereditary disorders, blood coagulation, growth factors, hematopoiesis and differentiation is contained in first-rate basic and clinical papers some of which are accompanied by editorial comments by eminent experts. These are supplemented by short state-of-the-art communications, reviews and correspondence as well as occasional special issues devoted to ‘hot topics’ in hematology. These will keep the practicing hematologist well informed of the new developments in the field.