Antithymocyte globulin before allogeneic stem cell transplantation for progressive myelodysplastic syndrome: a study from the French Society of Bone Marrow Transplantation and Cellular Therapy.
We investigated the impact of rabbit antithymocyte globulins (ATG) on patient outcomes after allogeneic stem cell transplantation (allo-SCT) for progressive myelodysplastic syndrome (MDS). Of the 242 consecutive patients who underwent allo-SCT for progressive MDS between October 1999 and December 2009, 93 received ATG (ATG group) at the median dose of 5 mg/kg, whereas 149 patients did not (no-ATG group). Donors were sibling (n = 153) or HLA-matched unrelated (n = 89). Patients received blood (n = 90) or marrow (n = 152) grafts after either myeloablative (n = 109) or reduced-intensity (n = 133) conditioning. Three-year overall and event-free survival, nonrelapse mortality, relapse, and chronic graft-versus-host disease (GVHD) development were not significantly different between the 2 groups. In contrast, acute grade II to IV GVHD occurred more often in the no-ATG group (55% of the patients) than in the ATG group (27%, P < .0001). Similar results were observed with acute grade III to IV GVHD (28% and 14% in the no-ATG group and ATG group, respectively; P = .009). In multivariate analysis, after adjustment with propensity score, the absence of ATG was the strongest parameter associated with an increased risk of acute grade II to IV GVHD (hazard ratio, 2.13; 95% confidence interval, 1.35 to 3.37; P = .001]. ATG had no impact on overall and event-free survival or cumulative incidence of the relapse. In conclusion, the addition of ATG to allo-SCT conditioning did not increase the incidence of relapse of patients with progressive MDS. The incidence of acute GVHD was decreased without compromising outcomes.
Department of Hematology and Bone Marrow Transplantation, CHRU Lille, Lille, France.
Rémy
R
Duléry
Department of Hematology and Bone Marrow Transplantation, Saint Antoine Hospital, Paris, France; Division of Hematology, University Pierre et Marie Curie, Paris, France; INSERM, UMRs 938, Paris, France.
Mohamad
M
Mohty
Department of Biostatistics, CRHU Lille, Lille, France.
Alain
A
Duhamel
Department of Hematology-Transplantation, Saint-Louis Hospital, Paris, France.
Marie
M
Robin
Department of Hematology, CHU of Liège and University of Liège, Liège, Belgium.
Yves
Y
Beguin
Department of Hematology, University Hospital, Lyon, France.
Mauricette
M
Michallet
Department of Hematology, University Hospital, Bordeaux, France.
Stéphane
S
Vigouroux
Department of Hematology, University Hospital, Strasbourg, France.
Bruno
B
Lioure
Department of Hematology, Pitié-Salpêtrière Hospital, Paris, France.
Alice
A
Garnier
Department of Hematology, Institut Paoli-Calmettes, Marseille, France.
Jean
J
El Cheikh
Department of Hematology, University Hospital, Grenoble, France.
Claude-Eric
CE
Bulabois
Department of Hematology, University Hospital Purpan, Toulouse, France.
Anne
A
Huynh
Department of Hematology, University Hospital, Clermont Ferrand, France.
Jacques-Olivier
JO
Bay
Department of Hematology, University Hospital, Besançon, France.
Etienne
E
Daguindau
Department of Hematology, University Hospital Montpellier, Montpellier, France.
Patrice
P
Ceballos
Department of Hematology, University Hospital, Nancy, France.
Laurence
L
Clément
Department of Hematology, University Hospital, Rennes, France.
Charles
C
Dauriac
Department of Hematology, University Hospital, Poitiers, France.
Natacha
N
Maillard
Department of Hematology, University Hospital, Nice, France.
Faezeh
F
Legrand
Department of Hematology, Institut de Cancérologie de la Loire, Saint Priest en Jarez, France.
Jérôme
J
Cornillon
Department of Hematology, University Hospital, Brest, France.
Gaëlle
G
Guillerm
Department of Hematology, University Hospital, Angers, France.
Sylvie
S
François
Department of Hematology and Bone Marrow Transplantation, Saint Antoine Hospital, Paris, France.
Simona
S
Lapusan
Department of Hematology, University Hospital, Nantes, France.
Patrice
P
Chevallier
Department of Hematology, University Hospital-CHU Sud, Amiens, France.
Gandhi
G
Damaj
Department of Hematology and Bone Marrow Transplantation, CHRU Lille, Lille, France. Electronic address: ibrahim.yakoubagha@chru-lille.fr.
Ibrahim
I
Yakoub-Agha
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D005602:France; D006086:Graft vs Host Disease / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012955:Societies, Medical; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods* / Q000401:mortality; D014184:Transplantation, Homologous
D000961:Antilymphocyte Serum; D019653:Myeloablative Agonists
Allogeneic stem cell transplantation; Antithymocyte globulin; Conditioning regimen; Graft-versus-host disease; Myelodysplastic syndrome