Dual T-cell depletion with individually tailored anti-thymocyte globulin and attenuated dose of post-transplant cyclophosphamide in haploidentical peripheral stem cell transplantation

• Published in: Scientific reports 2024-06, Vol.14 (1), p.13885-9, Article 13885
• Main Authors: Kim, Dong Hyun, Shin, Dong-Yeop, Koh, Youngil, Kim, Inho, Yoon, Sung-Soo, Byun, Ja Min, Hong, Junshik
• Format: Article
• Language: English
• Subjects: 631/250/1904; 692/4028/67/1990/283; Adolescent; Adult; Anti-thymocyte globulin; Antilymphocyte serum; Antilymphocyte Serum - administration & dosage; Antilymphocyte Serum - therapeutic use; Busulfan; Cyclophosphamide; Cyclophosphamide - administration & dosage; Cyclophosphamide - therapeutic use; Female; Fludarabine; Globulins; Graft vs Host Disease - etiology; Graft vs Host Disease - prevention & control; Graft-versus-host disease; Graft-versus-host reaction; Haploidentical hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Humanities and Social Sciences; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - therapeutic use; Leukemia; Lymphocyte Depletion - methods; Lymphocytes T; Male; Middle Aged; multidisciplinary; Myelodysplastic syndrome; Myelodysplastic Syndromes - therapy; Peripheral Blood Stem Cell Transplantation - methods; Post-transplant cyclophosphamide; Prophylaxis; Retrospective Studies; Science; Science (multidisciplinary); Stem cell transplantation; Stem cells; T-Lymphocytes - immunology; Thymocytes; Transplantation Conditioning - methods; Transplantation, Haploidentical - methods; Young Adult
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-64361-5

This study aimed to assess the efficacy of dual T-cell suppression using individually tailored doses of antithymocyte globulin (ATG) and attenuated dose of post-transplant cyclophosphamide (PTCy) in haploidentical hematopoietic stem cell transplantation (haplo-HSCT). We conducted a retrospective analysis of 78 adults with acute leukemia or myelodysplastic syndrome who underwent haplo-HSCT using intravenous busulfan and fludarabine conditioning. Thirty-two patients received attenuated ATG/PTCy, while 46 patients received ATG (7.5 mg/kg) as GVHD prophylaxis. The 100-day cumulative incidence of grade III-IV (9.7% vs. 32.4%, P  = 0.018) acute GVHD, as well as 2-year moderate-severe chronic GVHD (13.9% vs. 43.9%, P  = 0.018) in the ATG/PTCy group were significantly lower than those in the ATG group. The 2-year overall survival was comparable between the two groups. However, 2-year GVHD-free, relapse-free survival in the ATG/PTCy group was significantly higher compared to that in the ATG group (38.9% vs. 21.7%, P  = 0.021). Moreover, during post-engraftment period, the ATG/PTCy group exhibited lower incidences of life-threatening bacterial (12.5% vs. 37%, P  = 0.033) and viral infection (0% vs. 17.4%, P  = 0.035) than the ATG group. In conclusion, the combination of individually tailored ATG and low-dose PTCy appears to be a promising strategy in haplo-HSCT.