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

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 ana...

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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
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Shin, Dong-Yeop
Koh, Youngil
Kim, Inho
Yoon, Sung-Soo
Byun, Ja Min
Hong, Junshik
description 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.
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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.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>38880835</pmid><doi>10.1038/s41598-024-64361-5</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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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
title Dual T-cell depletion with individually tailored anti-thymocyte globulin and attenuated dose of post-transplant cyclophosphamide in haploidentical peripheral stem cell transplantation
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