Jacobs Journal of Bone Marrow and Stem Cell Research
Increased Risk for Relapse if ATG is Included in Reduced-Intensity Conditioning HSCT with Sibling Donors
Published on: 2018-03-10
Introduction: The impact of in vivo T-cell depletion on transplantation outcomes in patients treated with reduced-intensity conditioning (RIC) remains controversial. Patients and Methods: The effect of ATG as part of the Fludarabin + busulphan RIC protocol before sibling donor HSCT was studied. Twenty-one patients were given ATG while 26 did not receive ATG before HSCT. All patients had AML or MDS/MPN, received CsA and MTX as GVHD prophylaxis and received PBSC. Results: Overall survival at 5 years was 43% in ATG patients and 88% in patients not given ATG (p<0.01). Non-relapse mortality (NRM) was 14% and 4% at one year in the two groups, respectively. The cumulative incidence of relapse at 5 years was 43% in ATG patients and 15% in patients not receiving ATG (p=0.025). Relapse-free survival (RFS) at 5 years was 38% and 81% (p<0.01), respectively. Cumulative incidences of acute GVHD grades II-IV was 24% and 44% (p=0.16), chronic GVHD was 52% and 78% in the two groups (p=0.08), respectively. Conclusion: This small study suggests that high dose ATG (8 mg/kg) in sibling donor RIC HSCT increase the risk for relapse and reduce overall survival. Removal of ATG resulted in excellent results.