• Sara Butera, Marco Cerrano, Lucia Brunello, Chiara Maria Dellacasa, Danilo Giuseppe Faraci, Sara Vassallo, Nicola Mordini, Roberto Sorasio, Francesco Zallio, Alessandro Busca, Benedetto Bruno, and Luisa Giaccone.
• Department of Oncology, SSD Trapianto Allogenico di Cellule Staminali, A.O.U. Città della Salute e della Scienza di Torino, Via Genova 3, 10126, Torino, Italy.
• Ann. Hematol. 2021 Jul 1; 100 (7): 1837-1847.

AbstractDespite the widespread use of rabbit anti-thymocyte globulin (ATG) to prevent acute and chronic graft-versus-host disease (aGVHD, cGVHD) after allogeneic hematopoietic cell transplantation (allo-HCT), convincing evidence about an optimal dose is lacking. We retrospectively evaluated the clinical impact of two different ATG doses (5 vs 6-7.5 mg/kg) in 395 adult patients undergoing HSCT from matched unrelated donors (MUD) at 3 Italian centers. Cumulative incidence of aGVHD and moderate-severe cGVHD did not differ in the 2 groups. We observed a trend toward prolonged overall survival (OS) and disease-free survival (DFS) with lower ATG dose (5-year OS and DFS 56.6% vs. 46.3%, p=0.052, and 46.8% vs. 38.6%, p=0.051, respectively) and no differences in relapse incidence and non-relapse mortality. However, a significantly increased infection-related mortality (IRM) was observed in patients who received a higher ATG dose (16.7% vs. 8.8% in the lower ATG group, p=0.019). Besides, graft and relapse-free survival (GRFS) was superior in the lower ATG group (5-year GRFS 43.1% vs. 32.4%, p=0.014). The negative impact of higher ATG dose on IRM and GRFS was confirmed by multivariate analysis. Our results suggest that ATG doses higher than 5 mg/kg are not required for MUD allo-HCT and seem associated with worse outcomes.

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