title: Impact of ATG-containing reduced-intensity conditioning after single- or double-unit allogeneic cord blood transplantation.
abstract: We analyzed 661 adult patients who underwent single-unit (n = 226) or double-unit (n = 435) unrelated cord blood transplantation (UCBT) following a reduced-intensity conditioning (RIC) consisting of low-dose total body irradiation (TBI), cyclophosphamide, and fludarabine (Cy/Flu/TBI200). Eighty-two patients received rabbit antithymocyte globulin (ATG) as part of the conditioning regimen (ATG group), whereas 579 did not (non-ATG group). Median age at UCBT was 54 years, and diagnoses were acute leukemias (51%), myelodysplastic syndrome/myeloproliferative neoplasm (19%), and lymphoproliferative diseases (30%). Forty-four percent of patients were transplanted with advanced disease. All patients received ≥4 antigens HLA-matched UCBT. Median number of collected total nucleated cells was 4.4 × 10(7)/kg. In the ATG group, on 64 evaluable patients, ATG was discontinued 1 (n = 27), 2 (n = 20), or > 2 days before the graft infusion (n = 17). In multivariate analyses, the use of ATG was associated with decreased incidence of acute graft-versus-host disease (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.17-0.55; P < .0001), higher incidence of nonrelapse mortality (HR, 1.68; 95% CI, 1.16-2.43; P = .0009), and decreased overall survival (HR, 1.69; 95% CI, 1.19-2.415; P = .003). Collectively, our results suggest that the use of ATG could be detrimental, especially if given too close to graft infusion in adults undergoing UCBT following Cy/Flu/TBI200 regimen.
authors.affiliation: Hôpital Saint Vincent de Paul, Groupe Hospitalier de l'Institut Catholique de Lille, Hematologie, Lille, France; University Lille 2, Lille, France; Lille Inflammation Research International Center (LIRIC) U995, Lille, France;
authors.forename: Laurent
authors.initials: L
authors.lastname: Pascal
authors.affiliation: Eurocord, Paris, France;
authors.forename: Luciana
authors.initials: L
authors.lastname: Tucunduva
authors.affiliation: Eurocord, Paris, France; Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France;
authors.forename: Annalisa
authors.initials: A
authors.lastname: Ruggeri
authors.affiliation: Hematology, Institut Paoli Calmettes, Marseille, France;
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: Hôpital Lapeyronie, Montpellier, France;
authors.forename: Patrice
authors.initials: P
authors.lastname: Ceballos
authors.affiliation: Hematology, University Hospital, Nantes, France;
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.affiliation: Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands;
authors.forename: Jan
authors.initials: J
authors.lastname: Cornelissen
authors.affiliation: Hematology, University Hospital, Poitiers, France;
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.affiliation: Hematology, University Hospital, Bordeaux, France;
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.affiliation: Hematology, University Medical Center Utrecht, Utrecht, The Netherlands;
authors.forename: Eefke
authors.initials: E
authors.lastname: Petersen
authors.affiliation: Division of Hematology, Medical University of Graz, Graz, Austria;
authors.forename: Werner
authors.initials: W
authors.lastname: Linkesch
authors.affiliation: Rigshospitalet, Copenhagen, Denmark;
authors.forename: Henrik
authors.initials: H
authors.lastname: Sengeloev
authors.affiliation: Eurocord, Paris, France;
authors.forename: Chantal
authors.initials: C
authors.lastname: Kenzey
authors.affiliation: Department of Haematological Medicine, King's College London and Kings College Hospital, London, United Kingdom;
authors.forename: Antonio
authors.initials: A
authors.lastname: Pagliuca
authors.affiliation: Department of Haematology/Oncology, University of Regensburg, Regensburg, Germany;
authors.forename: Ernst
authors.initials: E
authors.lastname: Holler
authors.affiliation: Division of Hematology, Department of Internal Medicine II, University Hospital of Würzburg, Würzburg, Germany;
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
authors.affiliation: Eurocord, Paris, France; Monacord, Monaco;
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.affiliation: Eurocord, Paris, France; Division of Hematology, Churchill Hospital, Oxford, United Kingdom; and.
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.affiliation: University Lille 2, Lille, France; Lille Inflammation Research International Center (LIRIC) U995, Lille, France; Hematology, University-Hospital of Lille, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D003520:Cyclophosphamide / Q000008:administration & dosage; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008232:Lymphoproliferative Disorders / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000188:drug therapy; D016016:Proportional Hazards Models; D019172:Transplantation Conditioning / Q000379:methods*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine