Open Access
Comparison of myeloablative and reduced intensity conditioning unrelated donor allogeneic peripheral blood stem cell transplant outcomes for AML using thymoglobulin for GVHD prophylaxis
Author(s) -
Dipenkumar Modi,
Vijendra K. Singh,
Seongho Kim,
Lois Ayash,
Abhinav Deol,
Voravit Ratanatharathorn,
Joseph P. Uberti
Publication year - 2021
Publication title -
annals of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.079
H-Index - 80
eISSN - 1432-0584
pISSN - 0939-5555
DOI - 10.1007/s00277-021-04445-8
Subject(s) - thymoglobulin , medicine , busulfan , fludarabine , total body irradiation , transplantation , gastroenterology , hematology , hematopoietic stem cell transplantation , regimen , surgery , oncology , chemotherapy , tacrolimus , cyclophosphamide
A head-to-head comparison of outcomes of unrelated donor allogeneic peripheral blood stem cell transplantation for AML between reduced intensity conditioning (RIC) and myeloablative conditioning (MAC) regimens using thymoglobulin for GVHD prophylaxis is limited. We evaluated outcomes of 122 AML patients who received either busulfan (Bu)/fludarabine (Flu)/low-dose total body irradiation (TBI) as RIC (n = 64, 52%) or Bu/Flu as MAC (n = 58, 48%), and thymoglobulin 4.5 mg/kg total dose between day - 3 to - 1 for GVHD prophylaxis. Grades III-IV acute GVHD (aGVHD) was lower with Bu/Flu/TBI compared with Bu/Flu (6.2% vs 26.1%, p = 0.009). At 1 year, Bu/Flu/TBI was associated with similar chronic GVHD (41.2% vs 44.8%, p = 0.75), OS (61.9% vs 56.9%, p = 0.69), relapse rate (29.9% vs 20.7%, p = 0.24), relapse-free survival (52.8% vs 50%, p = 0.80), non-relapse mortality (17.4% vs 29.3%, p = 0.41), and GVHD-free relapse-free survival (24.2% vs 27.5%, p = 0.80) compared with Bu/Flu. Multivariable analysis did not reveal any difference in outcomes between both regimens. In summary, thymoglobulin at 4.5 mg/kg did not have any adverse impact on survival when used with RIC regimen. Both Bu/Flu/TBI and Bu/Flu conditioning regimens yielded similar survival.