Impact of in vivo T-cell depletion in patients with myelodysplastic syndromes undergoing allogeneic hematopoietic stem cell transplant: a registry study from the Chronic Malignancies Working Party of the EBMT

Edouard Forcade, Sylvie Chevret, Jürgen Finke, Gerhard Ehninger, Francis Ayuk, Dietrich Beelen, Linda Koster, Arnold Ganser, Liisa Volin, Henrik Sengeloev, Mauricette Michallet, Johanna Tischer, Pavel Jindra, Maria Jesús Pascual Cascon, Yener Koc, Mutlu Arat, Agnieszka Tomaszewska, Patrick Hayden, Theo de Witte, Ibrahim Yakoub-AghaNicolaus Kröger, Marie Robin

Abstract

While in vivo T-cell depletion (TCD) is widely used, its benefit in patients with MDS still remains a matter of debate. This study evaluates the impact of TCD on outcomes, and compares ATG and alemtuzumab, in patients with MDS. 1284 patients from the EBMT registry were included in this study with 470 patients in the no-TCD group and 814 in the TCD group (alemtuzumab N = 168; ATG N = 646). At 6 months, aGVHD III-IV cumulative incidences (CI) for no-TCD, ATG or alemtuzumab groups were 13% vs 14% vs 11% (ns), respectively. At 5 years, CI of chronic GVHD were 64% vs 52% vs 51% (p < 0.00017); and CI of relapse was 23% vs 25% vs 39% (p < 0.0001) for no TCD, ATG and alemtuzumab respectively; OS was 47% vs 46% vs 34% (p = 0.009) respectively; and GRFS was 21% vs 28% and 20% (p = 0.045) respectively. In multivariable analysis, ATG improved GRFS, and alemtuzumab decreased OS. Both ATG and alemtuzumab decreased risk of chronic GVHD, but the increased risk of relapse with alemtuzumab is associated with a poor GRFS and suggest to not use alemtuzumab in the setting of allo-SCT for high risk disease.

Original languageEnglish
JournalBone Marrow Transplantation
Volume57
Issue number5
Pages (from-to)768-774
Number of pages7
ISSN0268-3369
DOIs
Publication statusPublished - May 2022

Keywords

  • Alemtuzumab/therapeutic use
  • Graft vs Host Disease/etiology
  • Hematopoietic Stem Cell Transplantation/adverse effects
  • Humans
  • Myelodysplastic Syndromes/complications
  • Neoplasms/complications
  • Recurrence
  • Registries
  • Retrospective Studies
  • T-Lymphocytes
  • Transplantation Conditioning/adverse effects
  • Transplantation, Homologous/adverse effects
  • Treatment Outcome

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