Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Apr;100(4):969-978.
doi: 10.1007/s00277-021-04445-8. Epub 2021 Feb 16.

Comparison of myeloablative and reduced intensity conditioning unrelated donor allogeneic peripheral blood stem cell transplant outcomes for AML using thymoglobulin for GVHD prophylaxis

Dipenkumar Modi  1 , Vijendra Singh  2 , Seongho Kim  3 , Lois Ayash  2 , Abhinav Deol  2 , Voravit Ratanatharathorn  2 , Joseph P Uberti  2
Affiliations
Comparative Study

Comparison of myeloablative and reduced intensity conditioning unrelated donor allogeneic peripheral blood stem cell transplant outcomes for AML using thymoglobulin for GVHD prophylaxis

Dipenkumar Modi et al. Ann Hematol. 2021 Apr.

Abstract

A head-to-head comparison of outcomes of unrelated donor allogeneic peripheral blood stem cell transplantation for AML between reduced intensity conditioning (RIC) and myeloablative conditioning (MAC) regimens using thymoglobulin for GVHD prophylaxis is limited. We evaluated outcomes of 122 AML patients who received either busulfan (Bu)/fludarabine (Flu)/low-dose total body irradiation (TBI) as RIC (n = 64, 52%) or Bu/Flu as MAC (n = 58, 48%), and thymoglobulin 4.5 mg/kg total dose between day - 3 to - 1 for GVHD prophylaxis. Grades III-IV acute GVHD (aGVHD) was lower with Bu/Flu/TBI compared with Bu/Flu (6.2% vs 26.1%, p = 0.009). At 1 year, Bu/Flu/TBI was associated with similar chronic GVHD (41.2% vs 44.8%, p = 0.75), OS (61.9% vs 56.9%, p = 0.69), relapse rate (29.9% vs 20.7%, p = 0.24), relapse-free survival (52.8% vs 50%, p = 0.80), non-relapse mortality (17.4% vs 29.3%, p = 0.41), and GVHD-free relapse-free survival (24.2% vs 27.5%, p = 0.80) compared with Bu/Flu. Multivariable analysis did not reveal any difference in outcomes between both regimens. In summary, thymoglobulin at 4.5 mg/kg did not have any adverse impact on survival when used with RIC regimen. Both Bu/Flu/TBI and Bu/Flu conditioning regimens yielded similar survival.

Keywords: Acute myeloid leukemia (AML); Allogeneic stem cell transplantation; Myeloablative conditioning regimen; Reduced intensity conditioning regimen; Thymoglobulin (ATG); Unrelated donor transplant.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest Not applicable

Figures

Fig. 1
Fig. 1
a Cumulative incidence curves for grades III–IV acute GVHD (aGVHD III–IV) with disease relapse or death as competing risks by conditioning regimen. b Cumulative incidence curves for chronic GVHD (cGVHD) with disease relapse or death as competing risks by conditioning regimen
Fig. 2
Fig. 2
a Cumulative incidence curves for non-relapse mortality (NRM) with death with relapse as a competing risk by conditioning regimen. b Cumulative incidence curves for relapse with death without relapse as a competing risk by conditioning regimen
Fig. 3
Fig. 3
a Kaplan-Meier survival curves for relapse-free survival (RFS) by conditioning regimen. b Kaplan-Meier survival curves for GVHD-free relapse-free survival (GRFS) by conditioning regimen. c Kaplan-Meier survival curves for overall survival (OS) by conditioning regimen
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Peccatori J, Ciceri F (2010) Allogeneic stem cell transplantation for acute myeloid leukemia. Haematologica 95(6):857–859. 10.3324/haematol.2010.023184 - DOI - PMC - PubMed
    1. Scott BL, Pasquini MC, Logan BR, Wu J, Devine SM, Porter DL, Maziarz RT, Warlick ED, Fernandez HF, Alyea EP, Hamadani M, Bashey A, Giralt S, Geller NL, Leifer E, Le-Rademacher J, Mendizabal AM, Horowitz MM, Deeg HJ, Horwitz ME (2017) Myeloablative versus reduced-intensity hematopoietic cell transplantation for acute myeloid leukemia and myelodysplastic syndromes. J Clin Oncol 35(11):1154–1161. 10.1200/JCO.2016.70.7091 - DOI - PMC - PubMed
    1. Cahn JY, Labopin M, Schattenberg A, Reiffers J, Willemze R, Zittoun R, Bacigalupo A, Prentice G, Gluckman E, Herve P, Gratwohl A, Gorin NC (1997) Allogeneic bone marrow transplantation for acute leukemia in patients over the age of 40 years. Acute Leukemia Working Party of the European Group for Bone Marrow Transplantation (EBMT). Leukemia 11(3):416–419. 10.1038/sj.leu.2400573 - DOI - PubMed
    1. Wallen H, Gooley TA, Deeg HJ, Pagel JM, Press OW, Appelbaum FR, Storb R, Gopal AK (2005) Ablative allogeneic hematopoietic cell transplantation in adults 60 years of age and older. J Clin Oncol 23(15):3439–3446. 10.1200/JCO.2005.05.694 - DOI - PubMed
    1. Zikos P, Van Lint MT, Frassoni F, Lamparelli T, Gualandi F, Occhini D, Mordini N, Berisso G, Bregante S, De Stefano F, Soracco M, Vitale V, Bacigalupo A (1998) Low transplant mortality in allogeneic bone marrow transplantation for acute myeloid leukemia: a randomized study of low-dose cyclosporin versus low-dose cyclosporin and low-dose methotrexate. Blood 91(9): 3503–3508 - PubMed

Publication types

MeSH terms

LinkOut - more resources