Comparison of myeloablative and reduced intensity conditioning unrelated donor allogeneic peripheral blood stem cell transplant outcomes for AML using thymoglobulin for GVHD prophylaxis.

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Abstract

Title:: Comparison of myeloablative and reduced intensity conditioning unrelated donor allogeneic peripheral blood stem cell transplant outcomes for AML using thymoglobulin for GVHD prophylaxis.
Authors:: Modi D; Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA. .
Singh V; Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
Kim S; Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA.
Ayash L; Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
Deol A; Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
Ratanatharathorn V; Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
Uberti JP; Department of Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA.
Source:: Annals of hematology [Ann Hematol] 2021 Apr; Vol. 100 (4), pp. 969-978. Date of Electronic Publication: 2021 Feb 16.
Publication Type:: Comparative Study; Journal Article
Language:: English
Imprint Name(s):: Publication: Berlin : Springer Verlag
Original Publication: Berlin ; New York : Springer International, c1991-
MeSH Terms:: Peripheral Blood Stem Cell Transplantation*
Antilymphocyte Serum/*therapeutic use
Busulfan/*therapeutic use
Graft vs Host Disease/*prevention & control
Immunosuppressive Agents/*therapeutic use
Leukemia, Myeloid, Acute/*therapy
Myeloablative Agonists/*therapeutic use
Transplantation Conditioning/*methods
Vidarabine/*analogs & derivatives
Aged ; Allografts ; Busulfan/adverse effects ; Female ; Graft vs Host Disease/etiology ; Humans ; Infections/epidemiology ; Lymphocyte Depletion ; Male ; Middle Aged ; Mycophenolic Acid/therapeutic use ; Myeloablative Agonists/adverse effects ; Progression-Free Survival ; Retrospective Studies ; T-Lymphocytes ; Tacrolimus/therapeutic use ; Treatment Outcome ; Unrelated Donors ; Vidarabine/adverse effects ; Vidarabine/therapeutic use ; Whole-Body Irradiation
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Grant Information:: P30 CA022453 United States CA NCI NIH HHS
Contributed Indexing:: Keywords: Acute myeloid leukemia (AML); Allogeneic stem cell transplantation; Myeloablative conditioning regimen; Reduced intensity conditioning regimen; Thymoglobulin (ATG); Unrelated donor transplant
Substance Nomenclature:: 0 (Antilymphocyte Serum)
0 (Immunosuppressive Agents)
0 (Myeloablative Agonists)
D7RD81HE4W (thymoglobulin)
FA2DM6879K (Vidarabine)
G1LN9045DK (Busulfan)
HU9DX48N0T (Mycophenolic Acid)
P2K93U8740 (fludarabine)
WM0HAQ4WNM (Tacrolimus)
Entry Date(s):: Date Created: 20210217 Date Completed: 20210325 Latest Revision: 20210917
Update Code:: 20240104
PubMed Central ID:: PMC8366386
DOI:: 10.1007/s00277-021-04445-8
PMID:: 33594448
: Academic Journal

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A head-to-head comparison of outcomes of unrelated donor allogeneic peripheral blood stem cell transplantation for AML between reduced intensity conditioning (RIC) and myeloablative conditioning (MAC) regimens using thymoglobulin for GVHD prophylaxis is limited. We evaluated outcomes of 122 AML patients who received either busulfan (Bu)/fludarabine (Flu)/low-dose total body irradiation (TBI) as RIC (n = 64, 52%) or Bu/Flu as MAC (n = 58, 48%), and thymoglobulin 4.5 mg/kg total dose between day - 3 to - 1 for GVHD prophylaxis. Grades III-IV acute GVHD (aGVHD) was lower with Bu/Flu/TBI compared with Bu/Flu (6.2% vs 26.1%, p = 0.009). At 1 year, Bu/Flu/TBI was associated with similar chronic GVHD (41.2% vs 44.8%, p = 0.75), OS (61.9% vs 56.9%, p = 0.69), relapse rate (29.9% vs 20.7%, p = 0.24), relapse-free survival (52.8% vs 50%, p = 0.80), non-relapse mortality (17.4% vs 29.3%, p = 0.41), and GVHD-free relapse-free survival (24.2% vs 27.5%, p = 0.80) compared with Bu/Flu. Multivariable analysis did not reveal any difference in outcomes between both regimens. In summary, thymoglobulin at 4.5 mg/kg did not have any adverse impact on survival when used with RIC regimen. Both Bu/Flu/TBI and Bu/Flu conditioning regimens yielded similar survival.

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