The EBMT recommends rabbit anti-thymocyte or anti-T-lymphocyte globulin (rATG/ATLG) as GVHD prophylaxis in matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). However, discrepancies between recommendations and clinical practice were reflected in the EBMT survey. Therefore, we performed retrospective EBMT registry analysis from 2014 to 2021 to reinforce the real-world evidence context of rATG/ATLG impact on post-transplantation outcomes. This study included 11,420 adult patients (non-ATG n = 7680 and ATG n = 3740) with hematological malignancies after the first allo-HCT from peripheral blood. Use of ATG was associated with a reduced risk of aGVHD II-IV (Day +100: non-ATG vs ATG, 27.6% vs. 21.6%; adjusted HR 0.7, p < 0.001) and cGVHD (2-year: non-ATG vs ATG, 48.9% vs 30%; adjusted HR 0.45, p < 0.001), improved OS (2-year: 62.9% vs 63.3%; adjusted HR 0.89, p = 0.009), reduced NRM (2-year: 16% vs 12.5%; adjusted HR 0.63, p < 0.001), and higher GRFS (2-year: 32.2% vs 40.7%; adjusted HR 0.72, p < 0.001). While RI was higher in the ATG group (2-year: non-ATG vs ATG, 30.2% vs 34.7%; adjusted HR 1.22, p < 0.001) it did not translate into a significantly lower PFS (2-year: 53.9% vs 52.8%; adjusted HR not significant). Overall, outcomes were favorable for the intermediate rATG/ATLG dose ranges compared to the low and high dose ranges. Administration of rATG/ATLG improved outcomes in MSD allo-HCT recipients, supporting the EBMT recommendation for its use.

Charité Department of Hematology Oncology and Tumorimmunology Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin Berlin Germany

Charles University Hospital Hradec Czech Republic

CHU de Lille Univ Lille INSERM U1286 Infinite Lille France

Department for Stem Cell Transplantation University Medical Center Hamburg Germany

Department of Hematology and Transplantology University Clinical Center Medical University of Gdańsk Gdańsk Poland

Division of Stem Cell Transplantation and Cellular Immunotherapies University Hospital Schleswig Holstein Campus Kiel Kiel University Kiel Germany

EBMT Paris Study Office CEREST TC INSERM UMR S 938 Sorbonne University Hôpital Saint Antoine Paris France

Institute of Hematology and Blood Transfusion Prague Czech Republic

IRCCS Ospedale Policlinico San Martino Genova Italy

IRCCS Ospedale San Raffaele s r l Milano Italy

Klinikum Augsburg Augsburg Germany

Klinikum Grosshadern Munich Germany

Medical Clinic and Policinic 1 Leipzig Germany

RM Gorbacheva Research Institute Pavlov University St Petersburg Russian Federation

Transplantation and Cellular Therapy Department of Hematology Institut Paoli Calmettes Management Sport Cancer Lab Lumin Aix Marseille University Marseille France

Universitaetsklinikum Goettingen Goettingen Germany

University Hospital Basel Basel Switzerland

University Hospital Centre Rijeka and School of Medicine University of Rijeka Rijeka Croatia

University Hospital Erlangen Erlangen Germany

University Hospital Essen Essen Germany

University Hospital Gasthuisberg Leuven Belgium

University Hospital TU Dresden Dresden Germany

University Medical Center Freiburg University of Freiburg Freiburg Germany

University Medical Center Mainz Mainz Germany

University of Heidelberg Heidelberg Germany

University of Muenster Muenster Germany

University of Regensburg Regensburg Germany

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