Alemtuzumab vs anti‐thymocyte globulin in patients transplanted from an unrelated donor after a reduced intensity conditioning

Objective Relapse and graft‐vs‐host disease (GVHD) are still the main complications after allogeneic hematopoietic stem cell transplantation, especially in the setting of reduced intensity regimen (RIC) and unrelated donor. We compared here anti‐thymocyte globulin (ATG) or alemtuzumab as GVHD prophy...

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Bibliographic Details
Published in:European journal of haematology 2018-10, Vol.101 (4), p.466-474
Main Authors: Robin, Marie, Raj, Kavita, Chevret, Sylvie, Gauthier, Jordan, Lavallade, Hugues, Michonneau, David, McLornan, Donal, Peffault de Latour, Régis, Potter, Victoria, Kulasekararaj, Austin, Sicre de Fontbrune, Flore, Pagliuca, Antonio, Yakoub‐Agha, Ibrahim, Socié, Gérard, Mufti, Ghulam J.
Format: Article
Language:English
Subjects:
alemtuzumab
Alemtuzumab - pharmacology
Alemtuzumab - therapeutic use
Antilymphocyte Serum - pharmacology
Antilymphocyte Serum - therapeutic use
anti‐thymocyte globulin
Cytogenetics
Female
Globulins
Graft vs Host Disease - etiology
Graft vs Host Disease - mortality
Graft vs Host Disease - prevention & control
Graft-versus-host reaction
graft‐vs‐host disease prophylaxis
Hematopoietic Stem Cell Transplantation - adverse effects
Hematopoietic stem cells
Histocompatibility antigen HLA
HLA Antigens - genetics
HLA Antigens - immunology
Humans
Immunotherapy
Lymphocyte Depletion
Male
Middle Aged
Monoclonal antibodies
Myeloid cells
myeloid disorder
Myeloproliferative Disorders - complications
Myeloproliferative Disorders - genetics
Myeloproliferative Disorders - therapy
Prognosis
Prophylaxis
Proportional Hazards Models
Stem cell transplantation
Transplantation Conditioning - adverse effects
Transplants & implants
Treatment Outcome
Unrelated Donors
unrelated transplant
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Summary:Objective Relapse and graft‐vs‐host disease (GVHD) are still the main complications after allogeneic hematopoietic stem cell transplantation, especially in the setting of reduced intensity regimen (RIC) and unrelated donor. We compared here anti‐thymocyte globulin (ATG) or alemtuzumab as GVHD prophylaxis in patients with myeloid disease transplanted after RIC and from an unrelated donor. Method ATG and alemtuzumab patients have been matched by age, gender, HLA matching, comorbidities and cytogenetics risk (119 patients in each group). Results After matching, we found that ATG decreased the risk of relapse (HR: 0.55, P = .0049) and improved relapse‐free survival (RFS, HR: 0.70, P = .042). The improved RFS with ATG was more pronounced in CMV‐positive patients but was not influenced by disease risk. Regarding overall survival, GVHD‐free relapse‐free survival and transplant‐related mortality, the risk was similar using ATG or alemtuzumab. Conclusion Even if GVHD risk is lowered by alemtuzumab use, it does not translate in better outcome due to higher risk of relapse.
ISSN:0902-4441
1600-0609
DOI:10.1111/ejh.13085