08.25.21

Anti-thymocyte globulin with CsA and MMF as GVHD prophylaxis in nonmyeloablative HLA-mismatched allogeneic HCT

A retrospective analysis study published in Bone Marrow Transplantation demonstrated the feasibility of using anti-thymocyte globulin (ATG) for HLA-mismatched truly nonmyeloablative Flu-TBI hematopoietic cell transplantation (HCT). This study provides among the first transplant outcome data on the impact of ATG in HLA-mismatched truly nonmyeloablative HCT.

Patients receiving allogeneic HCT are at risk of developing Graft Versus Host Disease (GVHD), which ultimately hinders patients' survival rates and their quality of life long-term. Nonmyeloablative regimens are commonly administered in elderly or otherwise medically unfit patient populations, but still possess the risk of GVHD. At 3-years, a GVHD free and relapse free survival rate (GRFS) of approximately 30% in HLA-matched donors is observed. Currently, a triple drug strategy comprised of cyclosporine A (CsA), mycophenolate mofetil (MMF) resulting in less GVHD in these patients has been employed.

In this study, the median age was 56 years, with 54% of patients being male. The researchers found a 52% overall survival (OS) rate, a 43% relapse-free survival, and 38% GVHD free and relapse free survival rate (GRFS) at 4-years. While the authors highlight the limitations of the retrospective nature of this study, these findings suggest that ATG may be used as an alternative to triple drug strategies.

Reference:

van der Velden, W.J.F.M., Choi, G., de Witte, M.A. et al. Anti-thymocyte globulin with CsA and MMF as GVHD prophylaxis in nonmyeloablative HLA-mismatched allogeneic HCT. Bone Marrow Transplant (2021).

https://doi.org/10.1038/s41409-021-01369-9

 

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