Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation
Posttransplant cyclophosphamide vs antithymocyte globulin in HLA-mismatched unrelated donor transplantation
复制标题
DOI：
10.1182/blood.2019000487
复制
发表时间：
2019-09-12
期刊：
影响因子：
20.3
通讯作者：
Mohty, Mohamad
中科院分区：
文献类型：
--
作者：
Battipaglia, Giorgia;Labopin, Myriam;Mohty, Mohamad
抗胸腺细胞球蛋白（ATG）的使用代表了接受错配非亲缘供者（MMUD）移植的患者中移植物抗宿主病（GVHD）预防的标准治疗。最近已经报道了移植后环磷酰胺（PTCY）在这种情况下的安全性和可行性，但没有研究比较PTCY与ATG在9/10 MMUD移植中的结局。使用欧洲血液和骨髓移植学会急性白血病工作组的登记数据，我们在9/10 MMUD设置中进行了配对分析，比较了这2种策略。93例接受PTCY的患者与179例接受ATG的患者相匹配。PTCY组严重急性GVHD发生率明显低于ATG组。前者的接受者也表现出更高的无白血病生存率和GVHD/无复发生存率（GRFS）。当进行亚组分析时，包括接受外周血干细胞治疗、完全缓解或接受相同相关免疫抑制剂治疗的患者，证实了PTCY优于ATG。与单倍相合的情况类似，在9/10 MMUD移植中使用PTCY是有效的抗GVHD预防。PTCY的使用也可能在长期疾病控制方面提供更好的结果。这些结果需要在大型前瞻性随机试验中得到证实。
The use of anti-thymocyte globulin (ATG) has represented the standard of care in graft-versus-host disease (GVHD) prophylaxis in patients undergoing a mismatched unrelated donor (MMUD) transplant. The safety and feasibility of posttransplant cyclophosphamide (PTCY) in this setting have been reported recently, but no study has compared the outcomes of PTCY vs ATGin 9/10 MMUD transplants. Using the registry data of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, we performed a matched-pair analysis comparing those 2 strategies in a 9/10 MMUD setting. Ninety-three patients receiving PTCY were matched with 179 patients receiving ATG. A significantly lower incidence of severe acute GVHD was observed with PTCY compared with ATG. Recipients of the former also showed higher leukemia-free survival and GVHD/relapse-free survival (GRFS). When performing a subgroup analysis including patients receiving peripheral blood stem cells, being in complete remission, or receiving the same associated immunosuppressive agents, superiority of PTCY over ATG was confirmed. Similar to the haploidentical setting, use of PTCY is an effective anti-GVHD prophylaxis in the 9/10 MMUD transplant. Use of PTCY may also provide better outcomes in long-term disease control. These results need confirmation in large prospective randomized trials.