Impact of the Recipient’s Pre-Treatment Blood Lymphocyte Count on Intended and Unintended Effects of Anti-T-Lymphocyte Globulin in Allogeneic Hematopoietic Stem Cell Transplantation
Alexander Nikoloudis,
Veronika Buxhofer-Ausch,
Christoph Aichinger,
Michaela Binder,
Petra Hasengruber,
Emine Kaynak,
Dagmar Wipplinger,
Robert Milanov,
Irene Strassl,
Olga Stiefel,
Sigrid Machherndl-Spandl,
Andreas Petzer,
Ansgar Weltermann,
Johannes Clausen
Affiliations
Alexander Nikoloudis
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Veronika Buxhofer-Ausch
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Christoph Aichinger
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Michaela Binder
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Petra Hasengruber
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Emine Kaynak
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Dagmar Wipplinger
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Robert Milanov
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Irene Strassl
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Olga Stiefel
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Sigrid Machherndl-Spandl
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Andreas Petzer
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Ansgar Weltermann
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Johannes Clausen
Ordensklinikum Linz—Elisabethinen, Department of Internal Medicine I: Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, 4020 Linz, Austria
Background: In allogeneic hematopoietic stem cell transplantation (HSCT), Anti-T-Lymphocyte Globulin (ATLG) may be used for the prevention of severe graft-versus-host disease (GVHD). ATLG targets both the recipient’s lymphocytes and those transferred with the graft. Assuming an inverse relation between the recipient’s absolute lymphocyte count (ALC) and exposure of remaining ATLG to the graft, we aim to evaluate the impact of the recipient’s ALC before the first ATLG administration on the benefits (prevention of GVHD and GVHD-associated mortality) and potential risks (increased relapse incidence) associated with ATLG. Methods: In recipients of HLA-matched, ATLG-based HSCT (n = 311), we assessed the incidence of acute GVHD, GVHD-related mortality and relapse, as well as other transplant-related outcomes, in relation to the respective ALC (divided into tertiles) before ATLG. Results: The top-tertile ALC group had a significantly increased risk of aGVHD (subhazard ratio (sHR) 1.81; [CI 95%; 1.14–2.88]; p = 0.01) and aGVHD-associated mortality (sHR 1.81; [CI 95%; 1.03–3.19]; p = 0.04). At the highest ATLG dose level (≥45 mg/kg), recipients with lowest-tertile ALC had a trend towards increased relapse incidence (sHR 4.19; [CI 95%; 0.99–17.7]; p = 0.05, n = 32). Conclusions: ATLG dosing based on the recipient’s ALC may be required for an optimal balance between GVHD suppression and relapse prevention.
