Reduced intensity allogeneic stem cell transplant with anti‐thymocyte globulin and post‐transplant cyclophosphamide in acute myeloid leukemia

• Published in: European journal of haematology 2019-11, Vol.103 (5), p.510-518
• Main Authors: Salas, Maria Queralt, Prem, Shruti, Atenafu, Eshetu G., Law, Arjun Datt, Lam, Wilson, Al‐Shaibani, Zeyad, Loach, David, Kim, Dennis (Dong Hwan), Michelis, Fotios V., Lipton, Jeffrey Howard, Kumar, Rajat, Mattsson, Jonas, Viswabandya, Auro
• Format: Article
• Language: English
• Subjects: Acute myeloid leukemia; Adult; Aged; allogeneic stem cell transplant; Allografts; Antilymphocyte Serum - administration & dosage; anti‐thymocyte globulin; Cyclophosphamide; Cyclophosphamide - administration & dosage; Disease-Free Survival; Female; Follow-Up Studies; Globulins; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Graft-versus-host reaction; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - therapy; Male; Medicin och hälsovetenskap; Middle Aged; Myeloid leukemia; Peripheral blood; post‐transplant cyclophosphamide; Prophylaxis; reduced intensity conditioning regimen; Stem cell transplantation; Stem cells; Survival Rate; Transplants & implants
• ISSN: 0902-4441; 1600-0609; 1600-0609
• DOI: 10.1111/ejh.13321

Objectives We aimed to study the efficacy of reduced intensity conditioning (RIC) allo‐HSCT combined with anti‐thymocyte globulin (ATG) and post‐transplant cyclophosphamide (PTCy) for graft‐versus‐host disease (GVHD) prophylaxis in AML. Methods One hundred forty‐seven patients were included. All patients underwent unmanipulated peripheral blood stem cell RIC allo‐HSCT. Median follow‐up was 12.8 months (range 0.5‐39). Results Median age was 58 years. Twenty‐nine (20%) recipients received 10/10 MRD grafts, 69 (47%) 10/10 MUD grafts, 20 (13.6%) 9/10 MMUD, and 29 (20%) haploidentical grafts. The cumulative incidence of grade II‐IV and III‐IV acute GVHD at day +100, and moderate/severe chronic GVHD at 1‐year were as follow: 14.3%, 1.4%, and 8.3%. There were no significant differences according to donor type (P = .46) and cumulative incidence of GVHD. One‐year overall survival (OS), relapse‐free survival (RFS), non‐relapse mortality, and GVHD‐free/Relapse‐free survival were as follows: 66.9% (95% CI 58.4‐74), 59.9%, and 18.7% and 53.7%. KPS ≤ 80 was predictive of worst OS (P = .04). Those recipients who received MUD transplants had better RFS (P = .01). Conclusions RIC allo‐HSCT combined with ATG and PTCy is safe and a potentially curative strategy and it is associated with impressive GRFS in AML.