Aydin Mesire, de Leeuw David C, Rutten Caroline E, Visser Otto J, Tang Man Wai, van Roessel Cinthy, Janssen Jeroen J W, Biemond Bart J, van de Loosdrecht Arjan A, Hazenberg Mette D, Meijer Ellen, Nur Erfan
Department of Hematology, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Hematology, Amsterdam University Medical Centers, Location VU Medical Center, Free University, Amsterdam, the Netherlands.
Br J Haematol. 2023 Nov;203(3):439-445. doi: 10.1111/bjh.19031. Epub 2023 Aug 10.
Graft-versus-host disease (GvHD) is a serious complication of allogeneic haematopoietic stem cell transplantation (HSCT). Both anti-thymocyte globulin (ATG) and post-transplant cyclophosphamide (PTCy) are used as lymphocyte-depleting strategies, yet a systematic comparison of transplantation outcomes between these two methods in matched unrelated donors (MUD) transplantations with non-myeloablative conditioning (NMC) is lacking. Adult patients with haematological malignancies who had undergone MUD HSCT with NMC regimens between 2014 and 2021 at 2 centres in Amsterdam (ATG: n = 95, PTCy: n = 90), were included in this retrospective study. Patient characteristics were comparable between the groups. The cumulative incidence of acute GvHD grade II-IV was 48% in the ATG group compared to 21% in the PTCy group (p < 0.001). The 3-year moderate/severe chronic GvHD was similar in both groups (p = 0.69). While the relapse rate was comparable between the groups (ATG 31% vs. PTCy 34%, p = 0.94), non-relapse mortality tended to be higher in the ATG group (17% vs. 9%, p = 0.069). Overall survival was similar in both groups (p = 0.12). In conclusion, PTCy-based regimens resulted in a significantly lower rate of acute GvHD than ATG-containing regimens in MUD transplantations with NMC. Whether PTCy results in improved overall survival as compared to ATG needs to be elucidated in larger prospective studies.
移植物抗宿主病（GvHD）是异基因造血干细胞移植（HSCT）的一种严重并发症。抗胸腺细胞球蛋白（ATG）和移植后环磷酰胺（PTCy）均被用作淋巴细胞清除策略，但在非清髓性预处理（NMC）的匹配无关供体（MUD）移植中，缺乏对这两种方法移植结局的系统比较。2014年至2021年期间，在阿姆斯特丹的2个中心接受NMC方案的MUD HSCT的成年血液系统恶性肿瘤患者被纳入这项回顾性研究。两组患者的特征具有可比性。ATG组急性GvHD II-IV级的累积发生率为48%，而PTCy组为21%（p<0.001）。两组3年中重度慢性GvHD相似（p=0.69）。虽然两组的复发率相当（ATG组31% vs. PTCy组34%，p=0.94），但ATG组的非复发死亡率倾向于更高（17% vs. 9%，p=0.069）。两组的总生存率相似（p=0.12）。总之，在NMC的MUD移植中，基于PTCy的方案导致急性GvHD的发生率显著低于含ATG的方案。与ATG相比，PTCy是否能提高总生存率需要在更大规模的前瞻性研究中阐明。
