Among patients undergoing allogeneic myeloablative peripheral blood stem cell transplantation, using anti-T cell lymphocyte globulin (ATLG) or post-transplant cyclophosphamide (PTCy) for prophylaxis against graft-vs-host disease (GVHD) appears not to affect long-term clinical outcomes, according to research published in Haematologica.
In many hematologic disease settings, allogeneic stem cell transplantation (allo-SCT) is potentially curative, though it carries a risk of treatment-related mortality (TRM), most notably in the form of severe GVHD. Although ATLG and PTCy are commonly used treatments to prevent GVHD occurrence, it is unknown which of the 2 therapies confers superior kinetic and clinical benefits.
Previous study shows that ATLG reduces in vivo T cell depletion, while PTCy impairs alloreactive T cell function. The comparative effects of PCTy vs ATLG on immune reconstitution are, however, unknown. For this retrospective study, researchers evaluated the kinetic and clinical consequences of ATLG vs PTCy for GVHD prophylaxis after allo-SCT.
Data for patients undergoing PCTy (123 patients) and ATLG (476 patients) were included. The mean ages in both groups were 50 years; the most common disease in the ATLG group was acute myeloid leukemia (206 patients; 43%) vs multiple myeloma in the PCTy group (38 patients; 31%). Prognostic scoring system data, as well as mean donor age and donor/recipient serology, were balanced between the groups. More patients in the PCTy group, however, had either a related donor transplant or a matched related donor transplant (both P <.001)
Patients in the PTCy group had delayed neutrophil engraftment compared with those in the ATLG group (median, 12 days vs 10 days, respectively; P <.001). Moderate and severe chronic GvHD, but not acute GVHD, were also more common in the PCTy group (44% vs 38% in the ATLG group, respectively; P =.005).
Immune reconstitution, as measured by immune-related cellular distributions, was faster in the ATLG group.
There was not, however, any evidence that use of PTCy led to worse NRM, relapse, disease-free survival, or overall survival rates.
“Even though difference in [immune reconstitution] have been translated into decreased incidence of infections and moderate/severe [chronic] GVHD in the ATLG group they had no impact on any of the other long term outcomes,” the authors wrote. “However, it remains undetermined which regimen is better as [GVHD] prophylaxis.”
Massoud R, Gagelmann N, Fritzsche-Friedland U, et al. Comparison of immune reconstitution between anti-T-lymphocyte globulin and post-transplant cyclophosphamide as acute graft-versus-host disease prophylaxis in allogeneic myeloablative peripheral blood stem cell transplantation. Haematologica. Published online April 8, 2021. doi:10.3324/haematol.2020.271445