Antihuman T Lymphocyte Globulin Fresenius in Graft-Versus-Host Disease Prophylaxis for Unrelated Hematopoietic Stem Cell Transplantation After Myeloablative Conditioning: A Long-Term Real-Life Retrospective Study

Abstract

Graft-versus-host disease (GvHD) is a frequent complication of hematopoietic stem cell transplantation (HSCT) and remains among the leading causes of post-transplant morbidity and mortality. Acute GvHD (aGvHD) affects 30%–50% of HSCT patients, while chronic GvHD (cGvHD) affects 30%–70%. In vivo T depletion using rabbit antithymocyte globulins (ATG) during conditioning has been shown to reduce the occurrence of both aGvHD and cGvHD, with no impact on overall survival (OS) or relapse [1]. Among available antihuman lymphocytes serums, ATG (Thymoglobulin; Sanofi-Genzyme, Saint-Germain-en-Laye, France) and ATG Fresenius (ATLG) (Grafalon; Neovii, Rapperswil-Jona, Switzerland) can be used as GvHD prophylaxis.

In myeloablative conditioning (MAC), ATG infusion is correlated with a significant reduction in aGvHD and cGvHD, with no impact on OS, relapse, disease-free survival (DFS), or non-relapse mortality (NRM). However, initial trials using a high dose of ATG reported an increased rate of lethal viral infections [2], such as cytomegalovirus (CMV) or Epstein–Barr virus (EBV).

Since little real-life data has been reported so far, we aimed to study the impact of ATLG on a long-term real-life perspective in unrelated transplantation after MAC.