Ex vivo and in vivo T cell-depleted allogeneic stem cell transplantation in patients with acute myeloid leukemia in first complete remission resulted in similar overall survival: on behalf of the ALWP of the EBMT and the MSKCC - Aix-Marseille Université Access content directly
Journal Articles Journal of Hematology and Oncology Year : 2018

Ex vivo and in vivo T cell-depleted allogeneic stem cell transplantation in patients with acute myeloid leukemia in first complete remission resulted in similar overall survival: on behalf of the ALWP of the EBMT and the MSKCC

Florent Malard
  • Function : Author
Myriam Labopin
Christina Cho
  • Function : Author
Esperanza B. Papadopoulos
  • Function : Author
Jakob Passweg
  • Function : Author
Richard O'Reilly
  • Function : Author
Edouard Forcade
Molly Maloy
  • Function : Author
Liisa Volin
  • Function : Author
Hugo Castro-Malaspina
  • Function : Author
Yosr Hicheri
  • Function : Author
Ann A. Jakubowski
  • Function : Author
Corentin Orvain
Sergio Giralt
  • Function : Author
Mohamad Mohty
Arnon Nagler
Miguel-Angel Perales

Abstract

Graft-versus-host disease (GVHD) is one of the leading causes of non-relapse mortality and morbidity after allogeneic hematopoietic stem cell transplantation (allo-HCT).MethodsWe evaluated the outcomes of two well-established strategies used for GVHD prevention: in vivo T cell depletion using antithymocyte globulin (ATG) and ex vivo T cell depletion using a CD34-selected (CD34+) graft. A total of 525 adult patients (363 ATG, 162 CD34+) with intermediate or high-risk cytogenetics acute myeloid leukemia (AML) in first complete remission (CR1) were included. Patients underwent myeloablative allo-HCT using matched related or unrelated donors.ResultsTwo-year overall survival estimate was 69.9% (95% CI, 58.5-69.4) in the ATG group and 67.6% (95% CI, 60.3-74.9) in the CD34+ group (p=0.31). The cumulative incidence of grade II-IV acute GVHD and chronic GVHD was higher in the ATG cohort [HR 2.0 (95% CI 1.1-3.7), p=0.02; HR 15.1 (95% CI 5.3-42.2), p<0.0001]. Parameters associated with a lower GVHD-free relapse-free survival (GRFS) were ATG [HR 1.6 (95% CI 1.1-2.2), p=0.006], adverse cytogenetic [HR 1.7 (95% CI 1.3-2.2), p=0.0004], and the use of an unrelated donor [HR 1.4 (95% CI 1.0-1.9), p=0.02]. There were no statistical differences between ATG and CD34+ in terms of relapse [HR 1.52 (95% CI 0.96-2.42), p=0.07], non-relapse mortality [HR 0.96 (95% CI 0.54-1.74), p=0.90], overall survival [HR 1.43 (95% CI 0.97-2.11), p=0.07], and leukemia-free survival [HR 1.25 (95% CI 0.88-1.78), p=0.21]. Significantly, more deaths related to infection occurred in the CD34+ group (16/52 vs. 19/112, p=0.04).ConclusionsThese data suggest that both ex vivo CD34-selected and in vivo ATG T cell depletion are associated with a rather high OS and should be compared in a prospective randomized trial.
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hal-02143644 , version 1 (19-10-2023)

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Florent Malard, Myriam Labopin, Christina Cho, Didier Blaise, Esperanza B. Papadopoulos, et al.. Ex vivo and in vivo T cell-depleted allogeneic stem cell transplantation in patients with acute myeloid leukemia in first complete remission resulted in similar overall survival: on behalf of the ALWP of the EBMT and the MSKCC. Journal of Hematology and Oncology, 2018, 11, ⟨10.1186/s13045-018-0668-3⟩. ⟨hal-02143644⟩

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