ALWP / EBMT研究：抗胸腺细胞球蛋白在HLA配型无关的HLA相合性异基因干细胞移植（HSCT）治疗二次AML康复中的作用。
The role of anti-thymocyte globulin in allogeneic stem cell transplantation (HSCT) from HLA-matched unrelated donors (MUD) for secondary AML in remission: a study from the ALWP /EBMT.
发表日期：2023 Sep 02
作者：
Arnon Nagler, Myriam Labopin, Nicolaus Kröger, Thomas Schroeder, Tobias Gedde-Dahl, Matthias Eder, Georg-Nikolaus Franke, Igor Wolfgang Blau, Urpu Salmenniemi, Gerard Socie, Johannes Schetelig, Matthias Stelljes, Fabio Ciceri, Mohamad Mohty
来源：
Cellular & Molecular Immunology
摘要：
我们比较了2010年至2021年之间，接受异基因移植的初次完全缓解状态（CR1）下班全部配型无关供者（MUD）治疗的1609名继发性急性髓系白血病（sAML）患者的疗效，其中一部分患者接受抗胸腺细胞球蛋白（ATG）（ATG-1308组），另一部分患者未接受ATG治疗（no ATG-301组）。中位年龄分别为60.9岁（范围为18.5-77.8岁）和61.1岁（范围为21.8-75.7岁），差异无显著性（p = 0.3）。移植物抗宿主病（GVHD）预防使用环孢素A联合甲氨蝶呤（41%）或魔风孢酯（38.2%），两组之间差异无显著性。移植后28天，植入率（ANC > 0.5 × 109/L）分别为92.3%和95.3%，差异无显著性（p = 0.17）。多因素分析表明，ATG组患者的Ⅱ-Ⅳ级和Ⅲ-Ⅳ级急性GVHD发病率较低（p = 0.002和p = 0.015），总体和广泛型慢性GVHD发病率较低（p = 0.008和p < 0.0001），复发率（RI）较低（p = 0.039），而非复发性死亡率（NRM）无显著差异（p = 0.51）。总生存率（OS）和无GVHD、无复发生存率（GRFS）在ATG组明显高于no ATG组，HR = 0.76（95% CI 0.61-0.95，p = 0.014）和HR = 0.68（95% CI 0.57-0.8，p < 0.0001），提示ATG对白血病无复发生存率（LFS）也有改善倾向，HR = 0.82（95% CI 0.67-1，p = 0.051）。主要死因是原发疾病、感染和GVHD。综上所述，尽管sAML是一种高风险疾病，ATG能够减少GVHD，提高LFS、OS和GRFS，并不会增加RI。©2023. The Author(s), under exclusive licence to Springer Nature Limited.
We compared outcomes, of 1609 patients with secondary acute myeloid leukemia (sAML) undergoing allogeneic transplantation (HSCT) in first complete remission (CR1) from matched unrelated donors (MUD) from 2010 to 2021, receiving or not receiving anti-thymocyte globulin (ATG) (ATG-1308, no ATG-301). Median age was 60.9 (range, 18.5-77.8) and 61.1 (range, 21.8-75.7) years, (p = 0.3). Graft versus host disease (GVHD) prophylaxis was cyclosporin-A with methotrexate (41%) or mycophenolate mofetil (38.2%), without significant differences between groups. Day 28, engraftment (ANC > 0.5 × 109/L) was 92.3% vs 95.3% (p = 0.17), respectively. On multivariate analysis, ATG was associated with lower incidence of grade II-IV and grade III-IV acute GVHD (p = 0.002 and p = 0.015), total and extensive chronic GVHD (p = 0.008 and p < 0.0001), and relapse incidence (RI) (p = 0.039), while non-relapse mortality (NRM) did not differ (p = 0.51). Overall survival (OS), and GVHD-free, relapse-free survival (GRFS) were significantly higher in the ATG vs no ATG group, HR = 0.76 (95% CI 0.61-0.95, p = 0.014) and HR = 0.68 (95% CI 0.57-0.8, p < 0.0001), with a tendency for better leukemia-free survival (LFS), HR = 0.82 (95% CI 0.67-1, p = 0.051). The main causes of death were the original disease, infection, and GVHD. In conclusion, ATG reduces GVHD and improves LFS, OS, and GRFS in sAML patients without increasing the RI, despite sAML being a high-risk disease.© 2023. The Author(s), under exclusive licence to Springer Nature Limited.