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. 2022 Feb 19;11(4):1106.
doi: 10.3390/jcm11041106.

Addition of a Single Low Dose of Anti T-Lymphocyte Globulin to Post-Transplant Cyclophosphamide after Allogeneic Hematopoietic Stem Cell Transplant: A Pilot Study

Elisabetta Xue  1 , Francesca Lorentino  1   2 , Maria Teresa Lupo Stanghellini  1 , Fabio Giglio  1 , Simona Piemontese  1 , Daniela Teresa Clerici  1 , Francesca Farina  1 , Sara Mastaglio  1 , Alessandro Bruno  1 , Edoardo Campodonico  1 , Rosamaria Nitti  1 , Magda Marcatti  1 , Andrea Assanelli  1 , Consuelo Corti  1 , Fabio Ciceri  1 , Jacopo Peccatori  1 , Raffaella Greco  1
Affiliations

Addition of a Single Low Dose of Anti T-Lymphocyte Globulin to Post-Transplant Cyclophosphamide after Allogeneic Hematopoietic Stem Cell Transplant: A Pilot Study

Elisabetta Xue et al. J Clin Med. .

Abstract

Correlation between risk of graft-versus-host disease (GvHD) and CD3+ counts within the peripheral blood stem cell graft has recently been reported in the setting of post-transplant cyclophosphamide (PT-Cy). We aimed to investigate the benefit of the addition of a single dose of anti-T lymphocyte globulin (ATLG 5 mg/kg) to PT-Cy in this setting. Starting in 2019, all patients receiving PBSC transplant containing CD3+ counts above 300 × 106/kg (study group) received a post-transplant dose of ATLG in addition to standard PT-Cy. The study was designed as a real-life analysis and included all consecutive Hematopoietic Stem Cell Transplantation (HSCT) recipients according to the above-mentioned inclusion criterion (n = 21), excluding cord blood and bone marrow donors. Using a 1:2 matched-pair analysis, we compared the outcomes with a historical population who received PT-Cy only (control group). We found a delayed platelet engraftment (29% vs. 45% at 30 days, p = 0.03) and a non-significant trend toward higher risk of poor graft function (29% vs. 19%, p = 0.52). The addition of ATLG impacted long-term immune reconstitution on the CD4+ subsets, but this did not translate into higher rate of relapse or viral infection. Acute GvHD was not significantly impacted, but 1-year cumulative incidence of chronic GvHD was significantly lower in the study group (15% vs. 41%, p = 0.04). Survival outcomes were comparable. In conclusion PT-Cy and ATLG was overall safe and translated into a low rate of chronic GvHD incidence.

Keywords: GvHD prophylaxis; anti-T lymphocyte globulin; post-transplant cyclophosphamide.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Chronic GvHD. Patients with a follow-up longer than 100 days were evaluated for cGvHD. (A) In the study group, 1-year cumulative incidence of cGvHD was 15% (95% CI 3–34) vs. 41% (95% CI 25–55) in the control group, p = 0.04. (B) In the study group, 1-year cumulative incidence of moderate-to-severe cGvHD was 10% (95% CI 2–28) vs. 31% (95% CI 18–45) in the control group, p = 0.07. Abbreviations: PT-Cy, post-transplant cyclophosphamide; ATG anti-T lymphocyte globulin; GvHD, Graft versus Host Disease; HSCT, hematopoietic stem cell transplant.
See this image and copyright information in PMC

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