Dual T-cell depletion with ATG and PTCy for peripheral blood reduced intensity conditioning allo-HSCT results in very low rates of GVHD

• Published in: Bone marrow transplantation (Basingstoke) Vol. 55; no. 9; pp. 1773 - 1783
• Main Authors: Salas, Maria Queralt, Prem, Shruti, Atenafu, Eshetu G, Datt Law, Arjun, Lam, Wilson, Al-Shaibani, Zeyad, Loach, David, Kim, Dennis Dong Hwan, Michelis, Fotios V, Lipton, Jeffrey Howard, Kumar, Rajat, Mattsson, Jonas, Viswabandya, Auro
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.09.2020
• Subjects: Activation; Antilymphocyte serum; Antithymocyte globulin; Blood; Conditioning; Cyclophosphamide; Depletion; Failure rates; Globulins; Graft rejection; Graft-versus-host reaction; Grafts; Health risks; Hematology; Lymphocytes T; Medicin och hälsovetenskap; Mud; Peripheral blood; Stem cell transplantation; T cells; Thymocytes
• ISSN: 0268-3369; 1476-5365; 1476-5365
• DOI: 10.1038/s41409-020-0813-9

The efficacy of posttransplant cyclophosphamide (PTCy) and antithymocyte globulin (ATG) in controlling GVHD has been previously reported. We aim to study the safety and efficacy of the use of dual T-cell depletion with ATG and PTCy for peripheral blood reduced intensity conditioning regimen allo-HSCT in 270 patients with hematological malignancies. Median follow-up was 12.7 months. Nineteen percent of patients received grafts from a matched related donor, 46% from 10/10 matched unrelated donors (MUD), 16% from 9/10 MUD and 19% from haploidentical donors. Graft failure rate was 9%. CMV and EBV reactivation rates were 58 and 64%. The cumulative incidence of grade II-IV and III-IV acute GVHD at day + 100 was 20.1% and 4.6%, respectively. The CI of moderate/severe chronic GVHD at 1 year was 12.4%. There were no differences in the incidence of GVHD according to donor type. One-year OS, RFS, NRM, CIR, and GVHD-free/RFS respectively were 65.2%, 56.9%, 22.7%, 20.3%, and 47.6%. Higher disease-risk index and worse Karnofsky performance status were significant factors for poor outcomes. In conclusion, the use of T-cell dual depletion with ATG and PTCy results in very low rates of acute and chronic GVHD and acceptable relapse rates and NRM.