RT Journal Article
T1 Tacrolimus plus sirolimus with or without ATG as GVHD prophylaxis in HLA-mismatched unrelated donor allogeneic stem cell transplantation.
A1 Kharfan-Dabaja, M A
A1 Parody, R
A1 Perkins, J
A1 Lopez-Godino, O
A1 Lopez-Corral, L
A1 Vazquez, L
A1 Caballero, D
A1 Falantes, J
A1 Shapiro, J
A1 Ortí, G
A1 Barba, P
A1 Valcárcel, D
A1 Esquirol, A
A1 Martino, R
A1 Piñana, J L
A1 Solano, C
A1 Tsalatsanis, A
A1 Pidala, J
A1 Anasetti, C
A1 Perez-Simón, J A
AB HLA-matched related or unrelated donors are not universally available. Consequently, patients can be offered hematopoietic stem cell transplantation (HSCT) from alternative donors, including mismatched unrelated donors (MMURD), known to cause a higher incidence of acute GVHD (aGVHD) and chronic GVHD. In vivo T-cell-depletion strategies, such as antithymocyte globulin (ATG) therapy, significantly decrease the risk of GVHD. We performed a multicenter, retrospective study comparing tacrolimus (TAC) and sirolimus (SIR) with or without ATG in 104 patients (TAC-SIR=45, TAC-SIR-ATG=59) who underwent MMURD HSCT. Use of ATG was associated with a lower incidence, albeit not statistically significant, of grades 2-4 aGVHD (46% vs 64%, P=0.09), no difference in grades 3-4 aGVHD (10% vs 15%, P=0.43), a trend for a lower incidence of moderate/severe chronic GVHD (16% vs 37%, P=0.09) and more frequent Epstein-Barr virus reactivation (54% vs 18%, P=0.0002). There were no statistically significant differences in 3-year overall survival (OS) (TAC-SIR-ATG=40% (95% confidence interval (CI)=24-56%) vs TAC-SIR=54% (95% CI=37-70%), P=0.43) or 3-year cumulative incidence of relapse/progression (TAC-SIR-ATG=40% (95% CI=28-58%) vs TAC-SIR=22% (95% CI=13-39%), P=0.92). An intermediate Center for International Blood & Marrow Transplant Research disease risk resulted in a significantly lower non-relapse mortality and better OS at 3 years. Our study suggests that addition of ATG to TAC-SIR in MMURD HSCT does not affect OS when compared with TAC-SIR alone.
YR 2016
FD 2016-11-07
LK http://hdl.handle.net/10668/10584
UL http://hdl.handle.net/10668/10584
LA en
DS RISalud
RD Apr 9, 2025