In this registry-based study which includes acute myeloid leukemia patients who underwent a matched unrelated donor allogeneic peripheral-blood stem cell transplantation in complete remission and received post-transplant cyclophosphamide (PTCY) as graft-versus-host disease (GvHD) prophylaxis, we compared 421 recipients without anti-thymocyte globulin (ATG) with 151 patients with ATG. The only significant differences between PTCY and PTCY + ATG cohorts were the median year of transplant and the follow-up period (2017 vs 2015 and 19.6 vs 31.1 months, respectively, p < 0.0001). Overall, 2-year survival was 69.9% vs 67.1% in PTCY and PTCY + ATG, respectively, with deaths related to relapse (39% vs 43.5%), infection (21.9% vs 23.9%) or GvHD (17.1% vs 17.4%) not differing between groups. On univariate comparison, a significantly lower rate of extensive chronic GvHD was found when ATG was added (9.9% vs 21%, p = 0.029), a finding which was not confirmed in the multivariate analysis. The Cox-model showed no difference between PTCY + ATG and PTCY alone with respect to acute and chronic GvHD of all grades, non-relapse mortality, relapse, leukemia-free survival, overall survival, and GvHD-free-relapse-free survival between study cohorts. Our results highlight that the addition of ATG in PTCY does not provide any extra benefit in terms of further GvHD reduction, better GRFS or better survival.

Bone Marrow Transplant Unit Medicana International Hospital Istanbul Turkey

Bone Marrow Transplantation Program Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon

Bone Marrow Transplantation Unit and Institute of Cellular Therapy University of Patras Patras Greece

Dél pesti Centrumkórház Budapest Hungary

Department of Hematology Hospital Saint Antoine Paris France

Department of Hematology University Medical Center Groningen University of Groningen Groningen the Netherlands

EBMT Statistical Unit Sorbonne Université Hospital Saint Antoine Paris France

Erasmus MC Cancer Institute University Medical Center Rotterdam Netherlands

Gorbacheva Research Institute Pavlov Univ St Petersburg Russian Federation

Hematology Division Chaim Sheba Medical Center Tel Hashomer Israel

Hôpital Lyon Sud Hospices Civils de Lyon Pierre Bénite France

Hospital Clinic Institute of Hematology and Oncology Barcelona Spain

Institute of Hematology and Blood Transfusion Prague Czech Republic

Maria Sklodowska Curie National Research Institute of Oncology Gliwice Poland

Ospedale San Raffaele s r l Haematology and BMT Milano Italy

Programme de Transplantation and Therapie Cellulaire Centre de Recherche en Cancérologie de Marseille Marseille France

University Hospital Eppendorf Bone Marrow Transplant Centre Hamburg Germany

University Hospital Maastricht Maastricht Netherlands

Vanderbilt University Medical Center Nashville TN USA

VU University Medical Center Amsterdam Netherlands

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