Antithymocyte Globulin before Allogeneic Stem Cell Transplantation for Progressive Myelodysplastic Syndrome: A Study from the French Society of Bone Marrow Transplantation and Cellular Therapy |
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| Affiliation: | 1. Department of Hematology and Bone Marrow Transplantation, CHRU Lille, Lille, France;2. Department of Hematology and Bone Marrow Transplantation, Saint Antoine Hospital, Paris, France;3. Division of Hematology, University Pierre et Marie Curie, Paris, France;4. INSERM, UMRs 938, Paris, France;5. Department of Biostatistics, CRHU Lille, Lille, France;6. Department of Hematology-Transplantation, Saint-Louis Hospital, Paris, France;7. Department of Hematology, CHU of Liège and University of Liège, Liège, Belgium;8. Department of Hematology, University Hospital, Lyon, France;9. Department of Hematology, University Hospital, Bordeaux, France;10. Department of Hematology, University Hospital, Strasbourg, France;11. Department of Hematology, Pitié-Salpêtrière Hospital, Paris, France;12. Department of Hematology, Institut Paoli-Calmettes, Marseille, France;13. Department of Hematology, University Hospital, Grenoble, France;14. Department of Hematology, University Hospital Purpan, Toulouse, France;15. Department of Hematology, University Hospital, Clermont Ferrand, France;16. Department of Hematology, University Hospital, Besançon, France;17. Department of Hematology, University Hospital Montpellier, Montpellier, France;18. Department of Hematology, University Hospital, Nancy, France;19. Department of Hematology, University Hospital, Rennes, France;20. Department of Hematology, University Hospital, Poitiers, France;21. Department of Hematology, University Hospital, Nice, France;22. Department of Hematology, Institut de Cancérologie de la Loire, Saint Priest en Jarez, France;23. Department of Hematology, University Hospital, Brest, France;24. Department of Hematology, University Hospital, Angers, France;25. Department of Hematology, University Hospital, Nantes, France;26. Department of Hematology, University Hospital-CHU Sud, Amiens, France |
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| Abstract: | We investigated the impact of rabbit antithymocyte globulins (ATG) on patient outcomes after allogeneic stem cell transplantation (allo-SCT) for progressive myelodysplastic syndrome (MDS). Of the 242 consecutive patients who underwent allo-SCT for progressive MDS between October 1999 and December 2009, 93 received ATG (ATG group) at the median dose of 5 mg/kg, whereas 149 patients did not (no-ATG group). Donors were sibling (n = 153) or HLA-matched unrelated (n = 89). Patients received blood (n = 90) or marrow (n = 152) grafts after either myeloablative (n = 109) or reduced-intensity (n = 133) conditioning. Three-year overall and event-free survival, nonrelapse mortality, relapse, and chronic graft-versus-host disease (GVHD) development were not significantly different between the 2 groups. In contrast, acute grade II to IV GVHD occurred more often in the no-ATG group (55% of the patients) than in the ATG group (27%, P < .0001). Similar results were observed with acute grade III to IV GVHD (28% and 14% in the no-ATG group and ATG group, respectively; P = .009). In multivariate analysis, after adjustment with propensity score, the absence of ATG was the strongest parameter associated with an increased risk of acute grade II to IV GVHD (hazard ratio, 2.13; 95% confidence interval, 1.35 to 3.37; P = .001]. ATG had no impact on overall and event-free survival or cumulative incidence of the relapse. In conclusion, the addition of ATG to allo-SCT conditioning did not increase the incidence of relapse of patients with progressive MDS. The incidence of acute GVHD was decreased without compromising outcomes. |
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| Keywords: | Conditioning regimen Graft-versus-host disease Myelodysplastic syndrome Allogeneic stem cell transplantation Antithymocyte globulin |
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