The use of haploidentical hematopoietic cell transplantation (haplo-HCT) with peripheral blood stem cells (PBSCs) to treat acute myelogenous leukemia (AML) is increasing. We explored whether the addition of antithymocyte globulin (ATG) to post-transplantation cyclophosphamide (PTCy) allows better outcomes compared with PTCy alone in haplo-HCT with PBSCs (haplo-PBSCT). We included 441 adult patients undergoing a first haplo-PBSCT for AML in first or second complete remission; graft-versus-host disease (GVHD) prophylaxis contained either PTCy alone (n = 374) or ATG plus PTCy (n = 67), in addition to cyclosporine A (CsA) and mycophenolate mofetil (MMF) as other immunosuppressive agents. All transplantations were performed between 2011 and 2019. No major imbalances were observed between the 2 groups. For both groups, the median patient age was 56 years, and the median year of haplo-PBSCT was 2017. Most patients received a reduced-intensity conditioning regimen (57% in the PTCy group and 61% in the ATG+PTCy group; P = .54). The median follow-up was 19 months in the PTCy group versus 15 months in the ATG+PTCy group (P = .59), and the rate of neutrophil engraftment in the 2 groups was 97% and 98%, respectively. In univariate analysis, there were no statistical differences in transplantation outcomes between the 2 groups. In multivariate analysis, ATG+PTCy was associated with a lower risk of chronic GVHD compared with PTCy alone (hazard ratio, .46; 95% confidence interval, .23 to .93; P = .03). No between-group differences in the other transplantation outcomes were seen. In haplo-PBSCT, the addition of ATG to PTCy (with CsA and MMF) is feasible and better at preventing chronic GVHD and is associated with survival and transplantation outcomes comparable to those with PTCy alone, without increasing transplantation toxicity, mortality, or relapse incidence.

Department of Clinical Medicine and Surgery Federico 2 University of Naples Naples Italy; Chaim Sheba Medical Center Tel Hashomer Israel

Department of Hematology Centre Hospitalier Universitaire de Nantes Nantes France

Department of Internal Medicine American University of Beirut Beirut Lebanon

European Society for Blood and Marrow Transplantation study office Paris France; Hematology Department Transplantation and Cellular Therapy Service Hôpital Saint Antoine Paris France; St Antoine Research Center INSERM Sorbonne University CRSA Hopital St Antoine Paris France

Haematology and BMT IRCCS Ospedale San Raffaele Milan Italy

Haematology and Haemotherapy Department Hospital General Universitario Gregorio Marañón Departamento de Medicina Instituto de Investigación Sanitaria Gregorio Marañon UCM Madrid Spain

Hematology Department ASST Grande Ospedale Metropolitano Niguarda Milan Italy

Hematology Department Centre Hospitalier Regional Universitaire Besançon INSERM UMR 1098 Université de Franche Comté Besançon France

Hematology Department Federico 2 University of Naples Naples Italy; Department of Clinical Medicine and Surgery Federico 2 University of Naples Naples Italy

Hematology Service Institute of Hematology and Blood Transfusion Prague Czech Republic

Hospital Ramón y Cajal Madrid Spain

Humanitas Clinical and Research Center IRCCS Milan Italy

Medicana International Istanbul Turkey

Transplantation and Cellular Therapy Program Institut Paoli Calmettes CNRS INSERM CRCM Aix Marseille Universitaire Marseille France

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