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Impact of Anti-Thymocyte Globulin on Results of Allogeneic Peripheral Blood Stem Cell Transplantation for Patients With Philadelphia-Positive Acute Lymphoblastic Leukaemia: An Analysis by the Acute Leukemia Working Party of the Ebmt Publisher Pubmed



Giebel S1 ; Labopin M2, 3 ; Czerw T1 ; Socie G4 ; Blaise D5 ; Ghavamzadeh A6 ; Passweg J7 ; Ljungman P8 ; Poire X9 ; Chevallier P10 ; Remenyi P11 ; Rambaldi A12 ; Anafasyev B13 ; Fegueux N14 Show All Authors
Authors
  1. Giebel S1
  2. Labopin M2, 3
  3. Czerw T1
  4. Socie G4
  5. Blaise D5
  6. Ghavamzadeh A6
  7. Passweg J7
  8. Ljungman P8
  9. Poire X9
  10. Chevallier P10
  11. Remenyi P11
  12. Rambaldi A12
  13. Anafasyev B13
  14. Fegueux N14
  15. Rovira M15
  16. Italaremes M16
  17. Bornhauser M17
  18. Mohty M2, 3
  19. Nagler A3, 18
Show Affiliations
Authors Affiliations
  1. 1. Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland
  2. 2. Hospital St. Antoine, Paris, France
  3. 3. Acute Leukemia Working Party of the EBMT, France
  4. 4. Hopital St. Louis, Paris, France
  5. 5. Institut Paoli Calmettes, Marseille, France
  6. 6. Shariati Hospital, Teheran, Iran
  7. 7. University Hospital, Basel, Switzerland
  8. 8. Karolinska University Hospital and Karolinska Institutet Stockholm, Sweden
  9. 9. Cliniques Universitaires St. Luc, Brussels, Belgium
  10. 10. CHU Nantes, Nantes, France
  11. 11. Del-pesti Centrumkorhaz –Orszagos Hematologiai es Infektologiai Intezet, Budapest, Hungary
  12. 12. Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
  13. 13. First State Pavlov Medical University of St. Petersburg, Russian Federation
  14. 14. CHU Lapeyronie, Montpellier, France
  15. 15. Hospital Clinic, Institute of Hematology & Oncology, Barcelona, Spain
  16. 16. HUCH Comprehensive Cancer Center, Helsinki, Finland
  17. 17. Universitaetsklinikum Dresden, Dresden, Germany
  18. 18. Chaim Sheba Medical Center, Tel-Hashomer, Israel

Source: European Journal of Cancer Published:2019


Abstract

Background: Anti-thymocyte globulin (ATG) is widely used to prevent graft-versus-host disease (GVHD) after allogeneic peripheral blood stem cell transplantation (alloPBSCT). The goal of this study was to retrospectively assess the effect of ATG on outcomes in the setting of Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ ALL). Methods: In the analysis, 1170 adult patients undergoing alloPBSCT from human leucocyte antigen–matched sibling or unrelated donors in the first complete remission between 2007 and 2016 were included. ATG was used in 429/575 (75%) and 121/595 (20%) patients transplanted from unrelated or sibling donors, respectively. Results: The incidence of chronic GVHD was 35% for patients treated with ATG compared with 52% in those not receiving ATG (p < 0.001), while the rate of extensive chronic GVHD was 16% and 36%, respectively (p < 0.001). The probability of survival free from GVHD and relapse (GRFS) was 42% and 32%, respectively (p = 0.002). In a multivariate model, the use of ATG was associated with reduced risk of overall chronic GVHD (hazard ratio [HR] = 0.52, p < 0.001) and extensive chronic GVHD (HR = 0.46, p < 0.001). It was also associated with better GRFS (HR = 0.77, p = 0.007), despite increased risk of relapse (HR = 1.41, p = 0.02). No significant effect was found with regard to the risk of non-relapse mortality and overall mortality. Conclusions: The use of ATG for patients with Ph+ ALL undergoing alloPBSCT is associated with reduced risk of chronic GVHD without impact on survival and therefore, could be considered. However, increased risk of relapse suggests the need for strict monitoring of minimal residual diseases and appropriate interventions after transplantation. © 2018 Elsevier Ltd
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