Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia
Arnon Nagler,
Abraham S. Kanate,
Myriam Labopin,
Fabio Ciceri,
Emanuele Angelucci,
Yener Koc,
Zafer Gülbas,
William Arcese,
Johanna Tischer,
Pietro Pioltelli,
Hakan Ozdogu,
Boris Afanasyev,
Depei Wu,
Mutlu Arat,
Zinaida Peric,
Sebastian Giebel,
Bipin Savani,
Mohamad Mohty
Affiliations
Arnon Nagler
Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel;
Abraham S. Kanate
West Virginia University, Morgantown, WV, USA;
Myriam Labopin
Haematology and EBMT Paris study office / CEREST-TC, Saint Antoine Hospital, Paris, France;
Fabio Ciceri
Ospedale San Raffaele s.r.l., Milano, Italy;
Emanuele Angelucci
Ospedale San Martino, Department of Haematology II, Genova, Italy;
Yener Koc
Medical Park Hospitals, Stem Cell Transplant Unit, Antalya, Turkey;
Zafer Gülbas
Anadolu Medical Center Hospital, Bone Marrow Transplantation Department, Kocaeli, Turkey;
William Arcese
Tor Vergata University of Rome, Stem Cell Transplant Unit, Rome, Italy;
Johanna Tischer
Klinikum Grosshadern, Med. Klinik III, Munich, Germany;
Pietro Pioltelli
Ospedale San Gerardo, Clinica Ematologica dell`Universita Milano-Biocca, Monza, Italy;
Hakan Ozdogu
Baskent University Hospital, Haematology Division, BMT Unit, Adana, Turkey;
Boris Afanasyev
First State Pavlov Medical University of St. Petersburg, Russia;
Depei Wu
First Affiliated Hospital of Soochow University, Department of Hematology, Suzhou, China;
Mutlu Arat
Florence Nightingale Sisli Hospital, Hematopoietic SCT Unit, Istanbul, Turkey;
Zinaida Peric
University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia;
Sebastian Giebel
Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland;
Bipin Savani
Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA;
Mohamad Mohty
Saint Antoine Hospital and Université Pierre et Marie Curie, Paris, France
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.
