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Comparative Study
. 2024 Sep;59(9):1265-1274.
doi: 10.1038/s41409-024-02328-w. Epub 2024 Jun 14.

Anti-T-lymphocyte globulin (ATLG) compared to post-transplant cyclophosphamide as GvHD prophylaxis in ALL patients undergoing allogeneic stem cell transplantation

Normann Steiner  1   2 , Radwan Massoud  1 , Evgeny Klyuchnikov  1 , Nico Gagelmann  1 , Johanna Richter  1 , Christian Niederwieser  1 , Kristin Rathje  1 , Tatjana Urbanowicz  1 , Ameya Kunte  1 , Janik Engelmann  1 , Christina Ihne  1 , Iryna Lastovytska  1 , Cecilia Lindhauer  1 , Franziska Marquard  1 , Mirjam Reichard  1 , Alla Ryzhkova  1 , Rusudan Sabauri  1 , Mathias Schäfersküpper  1 , Niloufar Seyedi  1 , Georgios Kalogeropoulos  1 , Silke Heidenreich  1 , Ina Rudolph  1 , Gaby Zeck  1 , Dietlinde Janson  1 , Christine Wolschke  1 , Francis Ayuk  1 , Nicolaus Kröger  3
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Comparative Study

Anti-T-lymphocyte globulin (ATLG) compared to post-transplant cyclophosphamide as GvHD prophylaxis in ALL patients undergoing allogeneic stem cell transplantation

Normann Steiner et al. Bone Marrow Transplant. 2024 Sep.

Abstract

We retrospectively analyzed high-risk ALL patients in CR1 receiving total body irradiation based conditioning regimen with ATLG (n = 74) or PTCy (n = 73) for GVHD prophylaxis. The 3-year OS and LFS were similar in both groups: 65 and 60% in the ATLG group and 64 and 67% in the PTCy group (p = 0.9 and 0.5, respectively). CIR and NRM rate at three years was 12 and 21% after PTCy and 19 and 20% after ATLG (p = 0.4 and p = 0.9, respectively). Acute GvHD grades II-IV and grades III/IV at 100 days was 46 and 19% after PTCy and 33 and 10% after ATLG (p = 0.08 and p = 0.9, respectively). Chronic GvHD of all grade at two years was higher after PTCy: 55% versus 26% (p < 0.001). Based on the propensity score matching (PSM) analysis, aGvHD grades II-IV was trending higher in the PTCy group compared to the ATLG group (p = 0.07). In contrast to the PSM analysis, on multivariate analysis the receipt of PTCy compared with ATLG was associated with a reduced CIR (p = 0.026). Our retrospective single-center analysis shows a lower incidence of acute and chronic GvHD while displaying similar LFS and OS after ATLG compared to PTCy in TBI based allogeneic stem cell transplantation for high-risk ALL.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Cumulative incidence of acute GvHD grades III–IV after alloSCT for ALL patients treated with ATLG or PTCy.
Comparison of the cumulative incidence of grades III–IV aGvHD over a 100-day period in ALL patients treated with ATLG or PTCy.
Fig. 2
Fig. 2. Cumulative incidence of chronic GvHD moderate/severe after alloSCT for ALL patients treated with ATLG or PTCy.
Comparison of cumulative incidence of moderate and severe cGvHD over a 3-year period in ALL patients treated with ATLG or PTCy.
Fig. 3
Fig. 3. Leukemia-free survival after alloSCT for ALL patients treated with ATLG or PTCy.
Comparison of leukemia-free survival in ALL patients treated with ATLG or PTCy over a 3-year period.
Fig. 4
Fig. 4. Overall survival after alloSCT for ALL patients treated with ATLG or PTCy.
Comparison of overall survival in ALL patients treated with ATLG or PTCy over a 3-year period.
Fig. 5
Fig. 5. GvHD relapse-free survival after alloSCT for ALL patients treated with ATLG or PTCy.
Comparison of relapse-free survival in ALL patients treated with ATLG or PTCy over a 3-year period.
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