• Sebastian Giebel, Myriam Labopin, Tomasz Czerw, Gérard Socié, Didier Blaise, Ardeshir Ghavamzadeh, Jacob Passweg, Per Ljungman, Xavier Poiré, Patrice Chevallier, Péter Reményi, Alessandro Rambaldi, Boris Anafasyev, Nathalie Fegueux, Montserrat Rovira, Maija Itälä-Remes, Martin Bornhäuser, Mohamad Mohty, and Arnon Nagler.
• Maria Sklodowska-Curie Institute - Cancer Center, Gliwice Branch, Gliwice, Poland. Electronic address: sgiebel@io.gliwice.pl.
• Eur. J. Cancer. 2019 Jan 1; 106: 212-219.

BackgroundAnti-thymocyte globulin (ATG) is widely used to prevent graft-versus-host disease (GVHD) after allogeneic peripheral blood stem cell transplantation (alloPBSCT). The goal of this study was to retrospectively assess the effect of ATG on outcomes in the setting of Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph+ ALL).MethodsIn the analysis, 1170 adult patients undergoing alloPBSCT from human leucocyte antigen-matched sibling or unrelated donors in the first complete remission between 2007 and 2016 were included. ATG was used in 429/575 (75%) and 121/595 (20%) patients transplanted from unrelated or sibling donors, respectively.ResultsThe incidence of chronic GVHD was 35% for patients treated with ATG compared with 52% in those not receiving ATG (p < 0.001), while the rate of extensive chronic GVHD was 16% and 36%, respectively (p < 0.001). The probability of survival free from GVHD and relapse (GRFS) was 42% and 32%, respectively (p = 0.002). In a multivariate model, the use of ATG was associated with reduced risk of overall chronic GVHD (hazard ratio [HR] = 0.52, p < 0.001) and extensive chronic GVHD (HR = 0.46, p < 0.001). It was also associated with better GRFS (HR = 0.77, p = 0.007), despite increased risk of relapse (HR = 1.41, p = 0.02). No significant effect was found with regard to the risk of non-relapse mortality and overall mortality.ConclusionsThe use of ATG for patients with Ph+ ALL undergoing alloPBSCT is associated with reduced risk of chronic GVHD without impact on survival and therefore, could be considered. However, increased risk of relapse suggests the need for strict monitoring of minimal residual diseases and appropriate interventions after transplantation.Copyright © 2018 Elsevier Ltd. All rights reserved.

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