Comparison of rabbit ATLG and ATG for GVHD prophylaxis in hematological malignancies with haploidentical hematopoietic stem cell transplantation

• Published in: Annals of hematology 2024-05, Vol.103 (5), p.1729-1736
• Main Authors: Tian, Zhengqin, Man, Qihang, Yang, Yixin, Guan, Hexian, Wang, Ying, Luo, Rongmu, Wang, Jingbo
• Format: Article
• Language: English
• Subjects: Disease prevention; Graft versus host disease; Hematology; Medicine; Medicine & Public Health; Oncology; Stem cell transplantation
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s00277-024-05724-w

Rabbit anti-human T lymphocyte globulin (ATLG) and anti-thymocyte globulin (ATG) are commonly used for graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT). Yet, their efficacy and safety have seldom been compared in hematological malignancies with haploidentical HSCT. A retrospective analysis with 28 ATLG (total dosage, 20–30 mg/kg) and 18 ATG (total dosage, 8–10 mg/kg) patients were performed. The cumulative incidences of chronic GVHD and relapse were comparable between both groups. ATLG showed a trend towards a lower acute GVHD incidence (28.6% vs. 44.4%, P  = 0.242) and 3-year non-relapse mortality (10.7% vs. 27.8%, P  = 0.160), and had a significantly higher 3-year overall survival (OS, 64.3% vs. 33.3%, P  = 0.033) and GVHD-free and relapse-free survival (GRFS, 32.1% vs. 11.1%, P  = 0.045) compared with ATG. Multivariate Cox regression analysis demonstrated ATLG was independently associated with a favorable OS (hazard ratio [HR] = 0.37, 95% confidence interval [CI]: 0.16–0.86, P  = 0.020) and GRFS (HR = 0.51, 95%CI: 0.26-1.00, P  = 0.051). Furthermore, ATLG had a lower risk of fever (25.0% vs. 61.1%, P  = 0.014) and hemorrhage cystitis (7.1% vs. 38.9%, P  = 0.008) than ATG-T. In conclusion, ATLG confers more survival benefit and a better safety profile than ATG and can be used in hematological malignancies with haploidentical HSCT. Prospective designed trials with a larger sample size are warranted to confirm the results in the future.