Researchers at the University Medical Center Hamburg-Eppendorf (UKE) have found differences in immune reconstitution (IR) when using anti-T-cell lymphocyte globulin (ATLG) or posttransplant cyclophosphamide (PTCy) as prophylaxis treatments for acute graft-versus-host disease (aGVHD). This retrospective study, published in the journal Haematologica, found a better IR for CD8+ T-cell, NK-cell, NKT-cell and gdT-cell when using ATLG, but better CD4+ recovery in the PTCy group.
As a treatment for hematological malignancies, allogeneic stem cell transplantation (allo-SCT) is a life-saving therapy. While allo-SCT may unfortunately have unwanted side effects such as GVHD, treatment with ATLG or PTCy can decrease this incidence. Since there is currently little data on the effects of ATLG or PTCy on IR post-allo-SCT with myeloablative conditioning (MAC), the authors sought to compare the differences between these treatments on IR kinetics.
In this study, IR (as measured by flow cytometry) in 123 PTCy and 476 ATLG treated patients were compared at day 30, 100, and 180 posttransplant. There were no differences observed between ATLG or PTCy groups for non-relapse mortality relapse incidence, disease-free survival, and overall survival. Overall, ATLG treated groups showed a faster reconstitution of CD3 T lymphocytes (CD3+) (p<0.05) and activated T cells (CD3+/HLADR+), compared to the PTCy treated group (p<0.05). Although these results suggest a decreased incidence of infection and moderate/severe chronic GVHD in the ATLG group, it is undetermined which treatment is advantageous.
Massoud R, Gagelmann N, Fritzsche-Friedland U, et al. Comparison of immune reconstitution between anti-T-lymphocyte globulin and posttransplant cyclophosphamide as acute graft-versus-host disease prophylaxis in allogeneic myeloablative peripheral blood stem cell transplantation. Haematologica. 2022;107(4):857-867. Published 2022 Apr 1.