Impact of antithymocyte globulin on outcomes of allogeneic hematopoietic cell transplantation with TBI

Arnon Nagler, Myriam Labopin, Bhagirathbhai Dholaria, Riitta Niittyvuopio, Johan Maertens, Xavier Poiré, Jan Cornelissen, Péter Reményi, Jean Henri Bourhis, Yves Beguin, Ram Malladi, Tessa Kerre, Wilfried Schroyens, Bipin N. Savani, Mohamad Mohty

Research output: Contribution to journalArticlepeer-review


The impact of the use of antithymocyte globulin (ATG) following a total body irradiation (TBI)–based myeloablative conditioning regimen has been poorly explored. We retrospectively analyzed 724 patients who underwent a first allogeneic hematopoietic cell transplantation (allo-HCT) following a TBI-based conditioning regimen for acute myeloid leukemia (AML) and compared the outcomes of 251 (35%) patients who received ATG (ATG group) with 473 (65%) patients who did not (non-ATG group). Median follow-up of surviving patients was 59 months (interquartile range, 28-83). The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) for non-ATG and ATG groups in the first 100 days was 33% vs 24%, respectively (P 5 .0098). The 2-year cumulative incidence of chronic graft-versus-host disease (cGVHD) was reduced significantly in the ATG group in comparison with the non-ATG group (46% vs 34%, P 5 .003). Using multivariate analysis, in vivo T-cell depletion (ATG group) was independently associated with a decreased incidence of grade II-IV aGVHD (hazard ratio [HR], 0.28; P, .001), grade III-IV aGVHD (HR, 0.21; P, .001), cGVHD (HR, 0.63; P 5 .02), and nonrelapse mortality (NRM) (HR, 0.54; P 5 .02). Relapse risk, overall survival, and leukemia-free survival were similar between the 2 groups. Our results suggest that the addition of ATG to TBI-based myeloablative conditioning for allo-HCT in AML patients results in a significant reduction in aGVHD and cGVHD, translating into a significant reduction in NRM without increasing the relapse rate.

Original languageEnglish
Pages (from-to)1950-1960
Number of pages11
JournalBlood advances
Issue number13
StatePublished - 2019


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