The impact of anti-thymocyte globulin on the outcomes of Patients with AML with or without measurable residual disease at the time of allogeneic hematopoietic cell transplantation.

Date publication

novembre 2019

Journal

Leukemia

Auteurs

Membres identifiés du Cancéropôle Est :
Pr DECONINCK Eric

Tous les auteurs :
Nagler A, Dholaria B, Labopin M, Socie G, Huynh A, Itälä-Remes M, Deconinck E, Yakoub-Agha I, Cahn JY, Bourhis JH, Labussière-Wallet H, Chantepie S, Esteve J, Savani B, Mohty M

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/31728052

Résumé

Measurable residual disease (MRD) status pre-allogeneic hematopoietic cell transplantation (allo-HCT) has been shown to predict transplant outcomes. We investigated the effect of Anti-Thymocyte Globulin (ATG) on acute myelogenous leukemia (AML) relapse by pretransplant MRD status. AML patients undergoing allo-HCT in first complete remission from either a matched sibling or unrelated donor during the 2006-2017 period were selected. Outcomes of 1509 patients (MRD, n = 426) were studied. ATG was used in 561 (52%) and 239 (58%) patients within the MRD and MRD cohorts, respectively. In MRD patients, ATG did not affect relapse incidence (RI) (HR = 0.80, p = 0.17), but was associated with reduced incidence of grade II-IV acute GVHD, grade II-IV and chronic GVHD, reduced nonrelapse mortality (HR = 0.66, p = 0.05), improved leukemia-free survival (HR = 0.74, p = 0.02), overall survival (HR = 0.69, p = 0.01), and GVHD-relapse free survival (HR = 0.62, p < 0.01). In MRD patients, ATG was associated with a lower incidence of chronic GVHD (total, HR 0.56 p = 0.03; extensive, HR 0.40 P = 0.01), without an impact on other allo-HCT outcome parameters, including RI(HR = 1.02, p = 0.92). The use of ATG was associated with reduced risk for GVHD. ATG did not increase RI, even in high-risk AML patients who were MRD before allo-HCT.

Référence

Leukemia. 2019 Nov 14;: