Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
Department of Prosthodontics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
Ann Hematol. 2021 Feb;100(2):529-540. doi: 10.1007/s00277-021-04399-x. Epub 2021 Jan 8.
Graft-versus-host disease (GVHD) prophylaxis based on post-transplant cyclophosphamide (PTCy) or antithymocyte globulin (ATG) is widely used in allogeneic hematopoietic stem cell transplantations (allo-HCT). The differential impacts of PTCy and ATG on transplantation outcomes are not well characterized. Here we report a meta-analysis of PTCy versus ATG in allo-HCT. Ten studies were eligible, and a total of 1871 patients were included. The incidence of II-IV aGVHD, III-IV aGVHD, and NRM were significantly lower in PTCy arm (HR = 0.63, 95% CI 0.45-0.89; HR = 0.35, 95% CI 0.16-0.77; HR = 0.59, 95% CI 0.48-0.73). PTCy was associated with a better OS and PFS (HR = 0.62, 95% CI = 0.53-0.73; HR = 0.76, 95% CI 0.62-0.93). The relapse rate and cGVHD incidence were not significantly different between PTCy and ATG (HR = 0.85, 95% CI 0.68-1.07; HR = 0.65, 95% CI 0.38-1.12). Thus, compared with ATG, PTCy has a better aGVHD control and OS benefit, without increasing relapse risk, which needs further validation in prospective randomized trials.
移植物抗宿主病（GVHD）预防基于移植后环磷酰胺（PTCy）或抗胸腺细胞球蛋白（ATG），广泛应用于异基因造血干细胞移植（allo-HCT）。PTCy 和 ATG 对移植结果的影响差异尚不清楚。本研究对 allo-HCT 中的 PTCy 与 ATG 进行了荟萃分析。符合条件的研究有 10 项，共纳入 1871 例患者。PTCy 组 II-IV 级 aGVHD、III-IV 级 aGVHD 和 NRM 的发生率显著降低（HR=0.63，95%CI 0.45-0.89；HR=0.35，95%CI 0.16-0.77；HR=0.59，95%CI 0.48-0.73）。PTCy 与更好的 OS 和 PFS 相关（HR=0.62，95%CI=0.53-0.73；HR=0.76，95%CI 0.62-0.93）。PTCy 与 ATG 组的复发率和 cGVHD 发生率无显著差异（HR=0.85，95%CI 0.68-1.07；HR=0.65，95%CI 0.38-1.12）。因此，与 ATG 相比，PTCy 具有更好的 aGVHD 控制和 OS 获益，而不会增加复发风险，这需要在前瞻性随机试验中进一步验证。
