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Anti-thymocyte globulin with CsA and MMF as GVHD prophylaxis in nonmyeloablative HLA-mismatched allogeneic HCT.
van der Velden, Walter J F M; Choi, Goda; de Witte, Moniek A; van der Meer, Arnold; de Haan, Anton F J; Blijlevens, Nicole M A; Huls, Gerwin; Kuball, Jürgen; van Dorp, Suzanne.
Affiliation
  • van der Velden WJFM; Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands. Walter.vanderVelden@Radboudumc.nl.
  • Choi G; Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
  • de Witte MA; Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
  • van der Meer A; Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
  • de Haan AFJ; Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Blijlevens NMA; Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Huls G; Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
  • Kuball J; Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
  • van Dorp S; Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
Bone Marrow Transplant ; 56(11): 2651-2655, 2021 11.
Article in En | MEDLINE | ID: mdl-34148060
Nonmyeloablative regimens are used for allogeneic hematopoietic cell transplantation (HCT) of older or medically unfit patients, but successful outcome is still hindered by graft-versus-host disease (GVHD), especially in the setting of HLA-mismatched HCT. New GVHD prophylaxis strategies are emerging, including the triple drug strategy, that improve the GVHD-free and relapse-free survival (GRFS). Because the impact of ATG in HLA-mismatched Flu-TBI-based nonmyeloablative HCT has not been investigated, we did a retrospective analysis in three Dutch centers. 67 patients were evaluable, with a median age of 56 years. Overall survival, relapse-free survival and GRFS at 4 years were 52%, 43%, and 38%, respectively. NRM findings and cumulative incidence of relapse at 4 years were 26% and 31%, respectively. At 1-year grade II-IV had occurred in 40% of the patients, and the incidence of moderate-severe chronic GVHD incidence was 16%. Acknowledging the limitations of retrospective analyses, we conclude that the use of ATG for HLA-mismatched truly nonmyeloablative Flu-TBI HCT is feasible and results in acceptable long term outcomes, especially with regards to GRFS. We consider ATG in combination with cyclosporin and mycophenolate mofetil as an alternative for the triple drug strategy that uses sirolimus for GVHD prophylaxis in this particular setting.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Hematopoietic Stem Cell Transplantation / Graft vs Host Disease Type of study: Etiology_studies / Observational_studies / Risk_factors_studies Limits: Humans / Middle aged Language: En Journal: Bone Marrow Transplant Journal subject: TRANSPLANTE Year: 2021 Document type: Article Affiliation country: Netherlands Country of publication: United kingdom

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Hematopoietic Stem Cell Transplantation / Graft vs Host Disease Type of study: Etiology_studies / Observational_studies / Risk_factors_studies Limits: Humans / Middle aged Language: En Journal: Bone Marrow Transplant Journal subject: TRANSPLANTE Year: 2021 Document type: Article Affiliation country: Netherlands Country of publication: United kingdom