Faculty Collaboration Database

Antithymocyte globulin before allogeneic stem cell transplantation for progressive myelodysplastic syndrome: a study from the French Society of Bone Marrow Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2014 May;20(5):646-54

Date

01/28/2014

Pubmed ID

24462982

DOI

10.1016/j.bbmt.2014.01.016

Scopus ID

2-s2.0-84897957278 (requires institutional sign-in at Scopus site)   23 Citations

Abstract

We investigated the impact of rabbit antithymocyte globulins (ATG) on patient outcomes after allogeneic stem cell transplantation (allo-SCT) for progressive myelodysplastic syndrome (MDS). Of the 242 consecutive patients who underwent allo-SCT for progressive MDS between October 1999 and December 2009, 93 received ATG (ATG group) at the median dose of 5 mg/kg, whereas 149 patients did not (no-ATG group). Donors were sibling (n = 153) or HLA-matched unrelated (n = 89). Patients received blood (n = 90) or marrow (n = 152) grafts after either myeloablative (n = 109) or reduced-intensity (n = 133) conditioning. Three-year overall and event-free survival, nonrelapse mortality, relapse, and chronic graft-versus-host disease (GVHD) development were not significantly different between the 2 groups. In contrast, acute grade II to IV GVHD occurred more often in the no-ATG group (55% of the patients) than in the ATG group (27%, P < .0001). Similar results were observed with acute grade III to IV GVHD (28% and 14% in the no-ATG group and ATG group, respectively; P = .009). In multivariate analysis, after adjustment with propensity score, the absence of ATG was the strongest parameter associated with an increased risk of acute grade II to IV GVHD (hazard ratio, 2.13; 95% confidence interval, 1.35 to 3.37; P = .001]. ATG had no impact on overall and event-free survival or cumulative incidence of the relapse. In conclusion, the addition of ATG to allo-SCT conditioning did not increase the incidence of relapse of patients with progressive MDS. The incidence of acute GVHD was decreased without compromising outcomes.

Author List

Duléry R, Mohty M, Duhamel A, Robin M, Beguin Y, Michallet M, Vigouroux S, Lioure B, Garnier A, El Cheikh J, Bulabois CE, Huynh A, Bay JO, Daguindau E, Ceballos P, Clément L, Dauriac C, Maillard N, Legrand F, Cornillon J, Guillerm G, François S, Lapusan S, Chevallier P, Damaj G, Yakoub-Agha I

Author

Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Aged
Antilymphocyte Serum
Chronic Disease
Female
France
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Histocompatibility Testing
Humans
Male
Middle Aged
Myeloablative Agonists
Myelodysplastic Syndromes
Societies, Medical
Survival Analysis
Tissue Donors
Transplantation Conditioning
Transplantation, Homologous