Role of antithymocyte globulin in matched sibling donor peripheral blood stem cell transplantation for hematologic malignancies

Abstract

Background: High incidence of chronic graft-versus-host disease (GVHD) has been a major drawback of matched sibling donor peripheral blood stem cell transplantation (MSD -PBSCT). This study aimed to investigate the safety and efficacy of antithymocyte globulin (ATG) as a standardized part of GVHD prophylaxis in patients receiving MSD -PBSCT.

Methods: A total of 72 patients with hematological malignancies receiving MSD -PBSCT who displayed similar baseline characteristics were either given rabbit ATG ( n = 42) or no ATG (n = 30), in addition to cyclosporine, methotrexate, and mycophenolate mofetil as a standard GVHD prophylaxis regimen. Either patients or donors aged ≥40 years were included in the study. Thymoglobulin was administered at a daily dose of 1.5 mg/kg on day -5 and 3.5 mg/kg on day -4 prior to transplant (the total dose was 5 mg/kg).

Results: After a median follow-up of 874 days, the 3-year cumulative incidence of chronic GVHD (cGVHD) was 37.3% in the ATG group and 52.1% in the non -ATG group. The 3-year overall and disease-free survival probability were 71.0% and 62.0% (ATG versus non -ATG, P = .262) and 66.7% and 58.4% (ATG versus non -ATG, P = .334). No difference was found in the 2-year cumulative incidence of nonrelapse mortality and relapse between the ATG and non -ATG groups. This significant reduction in the incidence of cGVHD without increased relapse risk and nonrelapse mortality led to a 3-year GVHD-free, relapse-free survival probability of 66.7% and 40.0% in the ATG and non-ATG groups, respectively.

Conclusions: These data suggested that rabbit antithymocyte globulin in the current protocol for GVHD prophylaxis was well tolerable and efficacious.The clinical trial was registered on January 1, 2016 (ClinicalTrials.gov Identifier NCT02677181). https://clinicaltrials.gov/ct2/show/NCT02677181.

Figure 1

Flow chart illustrating patient selection for analysis. ATG = antithymocyte globulin.

Figure 2

Cumulative incidence of aGVHD and cGVHD after MSD-PBSCT with rATG combined with cyclosporine, mycophenolate, and short-term methotrexate as GVHD prophylaxis compared with the non -ATG group. ATG = antithymocyte globulin, GVHD = graft-versus-host disease.

Figure 3

Cumulative incidence of NRM, relapse, OS, DFS, and GRFS after MSD-PBSCT with rATG combined with cyclosporine, mycophenolate, and short-term methotrexate for GVHD prophylaxis compared with the non -ATG group. ATG = antithymocyte globulin, DFS = disease-free survival, GRFS = severe GVHD-free, relapse-free survival, NRM = non-relapse mortality, OS = overall survival.