Anti-T-lymphocyte globulin (ATLG) compared to post-transplant cyclophosphamide as GvHD prophylaxis in ALL patients undergoing allogeneic stem cell transplantation

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2024年6月14日

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Normann Steiner,
Radwan Massoud,
Evgeny Klyuchnikov,
Nico Gagelmann,
Johanna Richter,
Christian Niederwieser,
Kristin Rathje,
Tatjana Urbanowicz,
Ameya Kunte,
Janik Engelmann,
Christina Ihne,
Iryna Lastovytska,
Cecilia Lindhauer,
Franziska Marquard,
Mirjam Reichard,
Alla Ryzhkova,
Rusudan Sabauri,
Mathias Schäfersküpper,
Niloufar Seyedi,
Georgios Kalogeropoulos,
Silke Heidenreich,
Ina Rudolph,
Gaby Zeck,
Dietlinde Janson,
Christine Wolschke,
Francis Ayuk,
Nicolaus Kröger

摘要

We retrospectively analyzed high-risk ALL patients in CR1 receiving total body irradiation based conditioning regimen with ATLG (n = 74) or PTCy (n = 73) for GVHD prophylaxis. The 3-year OS and LFS were similar in both groups: 65 and 60% in the ATLG group and 64 and 67% in the PTCy group (p = 0.9 and 0.5, respectively). CIR and NRM rate at three years was 12 and 21% after PTCy and 19 and 20% after ATLG (p = 0.4 and p = 0.9, respectively). Acute GvHD grades II-IV and grades III/IV at 100 days was 46 and 19% after PTCy and 33 and 10% after ATLG (p = 0.08 and p = 0.9, respectively). Chronic GvHD of all grade at two years was higher after PTCy: 55% versus 26% (p < 0.001). Based on the propensity score matching (PSM) analysis, aGvHD grades II-IV was trending higher in the PTCy group compared to the ATLG group (p = 0.07). In contrast to the PSM analysis, on multivariate analysis the receipt of PTCy compared with ATLG was associated with a reduced CIR (p = 0.026). Our retrospective single-center analysis shows a lower incidence of acute and chronic GvHD while displaying similar LFS and OS after ATLG compared to PTCy in TBI based allogeneic stem cell transplantation for high-risk ALL.