While in vivo T-cell depletion (TCD) is widely used, its benefit in patients with MDS still remains a matter of debate. This study evaluates the impact of TCD on outcomes, and compares ATG and alemtuzumab, in patients with MDS. 1284 patients from the EBMT registry were included in this study with 470 patients in the no-TCD group and 814 in the TCD group (alemtuzumab N = 168; ATG N = 646). At 6 months, aGVHD III-IV cumulative incidences (CI) for no-TCD, ATG or alemtuzumab groups were 13% vs 14% vs 11% (ns), respectively. At 5 years, CI of chronic GVHD were 64% vs 52% vs 51% (p < 0.00017); and CI of relapse was 23% vs 25% vs 39% (p < 0.0001) for no TCD, ATG and alemtuzumab respectively; OS was 47% vs 46% vs 34% (p = 0.009) respectively; and GRFS was 21% vs 28% and 20% (p = 0.045) respectively. In multivariable analysis, ATG improved GRFS, and alemtuzumab decreased OS. Both ATG and alemtuzumab decreased risk of chronic GVHD, but the increased risk of relapse with alemtuzumab is associated with a poor GRFS and suggest to not use alemtuzumab in the setting of allo-SCT for high risk disease.

Centre Hospitalier Lyon Sud Lyon France

Charles University Hospital Pilsen Czech Republic

CHU Bordeaux F 33000 Bordeaux France

CHU de Lille université de Lille LIRIC Inserm U995 59000 Lille France

Department of Hematology Oncology and Internal Medicine Medical University of Warsaw Warsaw Poland

Department of Medicine 1 Medical Center University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany

EBMT Data Office Leiden The Netherlands

Hannover Medical School Hannover Germany

Hopital Saint Louis APHP Université de Paris Paris France

Hospital Regional de Málaga Málaga Spain

HUCH Comprehensive Cancer Center Helsinki Finland

Medical Park Hospitals Antalya Turkey

Radboud University Nijmegen Medical Centre Nijmegen The Netherlands

Rigshospitalet Copenhagen Denmark

Sisli Florence Nightingale Hospital Istanbul Turkey

St James Hospital Dublin Ireland

Universitaetsklinikum Dresden Dresden Germany

University Hospital Eppendorf Hamburg Germany

University Hospital Essen Germany

University Hospital LMU Munich Department of Medicine 3 Munich Germany

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