Antithymocyte Globulin in Reduced-Intensity Conditioning Regimen Allows a High Disease-Free Survival Exempt of Long-Term Chronic Graft-versus-Host Disease

• Published in: Biology of blood and marrow transplantation 2014-03, Vol.20 (3), p.370-374
• Main Authors: Devillier, Raynier, Fürst, Sabine, El-Cheikh, Jean, Castagna, Luca, Harbi, Samia, Granata, Angela, Crocchiolo, Roberto, Oudin, Claire, Mohty, Bilal, Bouabdallah, Reda, Chabannon, Christian, Stoppa, Anne-Marie, Charbonnier, Aude, Broussais-Guillaumot, Florence, Calmels, Boris, Lemarie, Claude, Rey, Jèrôme, Vey, Norbert, Blaise, Didier
• Format: Article
• Language: English
• Subjects: Adult; Aged; Allogeneic stem cell transplantation; Antilymphocyte Serum - therapeutic use; Antineoplastic Agents - therapeutic use; Antithymocyte globulin; Busulfan - therapeutic use; Chronic Disease; Female; Graft vs Host Disease - immunology; Graft vs Host Disease - pathology; Hematologic Neoplasms - immunology; Hematologic Neoplasms - mortality; Hematologic Neoplasms - pathology; Hematologic Neoplasms - therapy; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Transplantation; Humans; Male; Middle Aged; Prospective Studies; Reduced-intensity conditioning; Survival Analysis; Transplantation Conditioning - methods; Transplantation, Homologous; Treatment Outcome; Vidarabine - analogs & derivatives; Vidarabine - therapeutic use
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2013.11.030

Abstract Nonmyeloablative (NMA) regimens allow the use of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients considered unfit for standard myeloablative conditioning (MAC) regimens using high-dose alkylating agents with or without total body irradiation (TBI). Reduced-intensity conditioning (RIC) regimens, based on fludarabine (Flu), busulfan (Bu), and rabbit antithymocyte globulin (r-ATG), represent an intermediate alternative between NMA and MAC regimens. This platform was subsequently optimized by the introduction of i.v. Bu and the use of 5 mg/kg r-ATG, based on the hypothesis that these modifications would improve the safety of RIC allo-HSCT. Here we report a study conducted at our institution on 206 patients, median age 59 years, who underwent allo-HSCT after conditioning with Flu, 2 days of i.v. Bu, and 5 mg/kg r-ATG (FBx-ATG) between 2005 and 2012. The prevalence of grade III-IV acute graft-versus-host disease (GVHD) was 9%, and that of extensive chronic GVHD was 22%. Four-year nonrelapse mortality (NRM), relapse, and overall survival (OS) rates were 22%, 36%, and 54%, respectively. NRM tended to be influenced by comorbidities (hematopoietic cell transplantation–specific comorbidity index [HCT-CI]