title: Impact of Thymoglobulin by Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors: A Report From the Société Française de Greffe de Moelle et de Thérapie Cellulaire.
abstract: BACKGROUND
  The impact of antithymocyte globulin (ATG) in the setting of a myeloablative conditioning transplantation remains controversial, especially when using bone marrow (BM) as the stem cell source.
  
  
  METHODS
  We therefore conducted a retrospective analysis to investigate the impact of ATG in patients with acute myeloid leukemia or myelodysplastic syndrome receiving myeloablative conditioning followed by a matched 10 of 10 unrelated donor transplant from BM or peripheral blood stem cells (PBSCs). Our study included 356 patients conditioned with cyclophosphamide associated with fractionated total body irradiation or busulfan.
  
  
  RESULTS
  Median follow-up was 17.6 months (range, 0-156). The ATG and PBSCs were the only variables that independently decreased the cumulative incidence (CI) of chronic graft-versus-host disease (GvHD) (hazards ratio [HR], 0.4; 95% CI, 0.21-0.73; P < 0.01; and HR, 0.53; 95% CI, 0.30-0.90; P = 0.02, respectively). The ATG had no impact on overall survival, disease-free survival, relapse, and nonrelapse mortality. In the PBSC group (n = 139), ATG was associated with a lower CI of both grades III to IV acute GvHD (HR, 0.17; 95% CI, 0.03-0.91; P = 0.04), chronic GvHD (HR, 0.31; 95% CI, 0.11-0.87; P = 0.03), and GvHD-free/relapse-free survival (HR, 0.48; 95% CI, 0.29-0.80; P < 0.01), whereas these correlations were not significant in the group of patients (n = 217) receiving BM (HR, 0.36; 95% CI, 0.11-1.93; P = 0.06 for grade III-IV acute GvHD; HR, 0.49; 95% CI, 0.22-1.06; P = 0.08 for chronic GvHD; and HR, 0.69; 95% CI, 0.46-1.01; P = 0.06 for GvHD-free/relapse-free survival).
  
  
  CONCLUSIONS
  Although our results confirm the recommendation for ATG to be added after PBSC transplantation, no obvious benefit was identified using this approach in the setting of BM transplantation. Only prospective studies may yield definitive answers to this question.
authors.affiliation: 1 Service d'hématologie Clinique Adulte et de Thérapie Cellulaire, CHU Estaing, Clermont Ferrand, France.2 Clermont Université, Université d'Auvergne, Clermont Ferrand, France.3 Hematologie/Transplantation, Hôpital St Louis, Paris, France.4 University Hospital and University of Bordeaux, Bordeaux, France.5 CHRU de Lille, France.6 Service d'Hématologie Goupe hospitalier Pitié-Salpétrière, Paris, France.7 Hopital Edouard Herriot, Lyon, France.8 Service d'hématologie, Centre Henri Becquerel, Rouen, France.9 Service d'oncologie Hématologique et Thérapie Cellulaire, CHU de Poitiers, Poitiers, France.10 Hopital Saint-Antoine, APHP, Paris, France.11 Université Pierre & Marie Curie, Paris, France.12 INSERM, Paris, France.13 Hôpital Necker, Paris, France.14 Hôpital Purpan CHU Toulouse, France.15 Department of Clinical Hematology, Rennes University Hospital, Rennes, F-35043, France.16 INSERM UMR 917, Rennes1 University, Rennes, France.17 Department of Hematology, University Hospital, Grenoble, France.18 CHU de Nice, Nice, France.19 Department of Hematology, AP-HP, Henri Mondor Hospital, France.20 University Paris Est Créteil (UPEC) Center for Clinical Investigation in Biotherapy, Créteil, France.21 CHU Hotel Dieu Nantes, France.22 CHU Caen, France.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Ravinet
authors.forename: Aurelie
authors.initials: A
authors.lastname: Cabrespine
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Noël
authors.initials: N
authors.lastname: Milpied
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub Agha
authors.forename: Stephanie
authors.initials: S
authors.lastname: Nguyen
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.forename: Anne Lise
authors.initials: AL
authors.lastname: Menard
authors.forename: Natacha
authors.initials: N
authors.lastname: Maillard
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Felipe
authors.initials: F
authors.lastname: Suarez
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.forename: Tony
authors.initials: T
authors.lastname: Marchand
authors.forename: Clémence
authors.initials: C
authors.lastname: Deteix
authors.forename: Jill Patrice
authors.initials: JP
authors.lastname: Cassuto
authors.forename: Sebastien
authors.initials: S
authors.lastname: Maury
authors.forename: Patrice
authors.initials: P
authors.lastname: Chevallier
authors.forename: Oumedaly
authors.initials: O
authors.lastname: Reman
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: Jacques Olivier
authors.initials: JO
authors.lastname: Bay
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000379:methods / Q000401:mortality; D002066:Busulfan / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005602:France; D006086:Graft vs Host Disease / Q000276:immunology / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019653:Myeloablative Agonists / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome; D061349:Unrelated Donors; D014916:Whole-Body Irradiation; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D003520:Cyclophosphamide; C512542:thymoglobulin; D002066:Busulfan