PTCy compared with ATG for the prevention of GVHD after alloSCT from MUD
Penack O, Abouqateb M, Peczynski C, et al. ATG or Post-Transplant Cyclophosphamide to Prevent GVHD in Matched Unrelated Stem Cell Transplantation?. Leukemia. 2024; (doi: 10.1038/s41375-024-02225-7).
Post-transplantation cyclophosphamide (PTCy) may be a superior option than rabbit anti-thymocyte globulin (rATG) for preventing graft-versus-host disease (GVHD) in adult recipients of peripheral blood allogeneic stem cell transplantation (allo-SCT) from matched, unrelated donors (MUD). Within this clinical context, researchers compared outcomes in 1,039 adults who underwent PTCy prophylaxis, an emerging alternative, and 7,725 who received rATG, which represents usual care in Europe. Transplantation for hematologic malignancies occurred between January 2018 and June 2021 in the EBMT database, and outcomes were evaluated 2 years post-procedure. Although randomized controlled trials are needed to validate the findings, the results favored PTCy over rATG. Investigators documented chronic GVHD at a rate of 28.4% among the PTCy recipients vs. 31.4% in the rATG group, although the incidence and severity of acute GVHD was comparable. Additional measurements for the PTCy group included a relapse rate of 22.8% and non-relapse mortality of 12.1%, which compared with rates of 26.6% and 16.4%, respectively, in the rATG group. PTCy patients also had better survival outcomes: overall survival of 73.1% vs. 65.9% in the rATG patients; progression-free survival of 64.9% vs. 57.2%; and GVHD-free relapse-free survival of 51% vs. 45%.