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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.

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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

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