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Outcomes of haploidentical peripheral blood stem cell transplantation following myeloablative conditioning using two types of rabbit ATG: a propensity score-matched analysis

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Abstract

During hematopoietic stem cell transplantation (HSCT), ATG depletes T cells in-vivo to improve engraftment and prevent graft-versus-host disease (GVHD). Here, we compared the clinical efficacy of two different types of ATGs: thymoglobulin and anti-human T-lymphocyte immunoglobulin (Grafalon). A total of 469 patients who received haploidentical transplantation were enrolled in this retrospective study. We applied a propensity score (PS)-matched analysis and 209 patients were assigned to each group. Clinical outcomes were compared between two groups and primary outcome was overall survival (OS). There was no significant difference in OS between two groups. Within the first 180 days after HSCT, Grafalon was associated with lower incidences of Epstein-Barr virus (EBV) viremia (31.6 vs. 54.5%, P < 0.0001) and cytomegalovirus viremia (CMV) viremia (54.5 vs. 67.9%, P = 0.005) compared to thymoglobulin. Patients receiving Grafalon had a higher rate of moderate/severe chronic GVHD (26.3 vs. 18.2%, P = 0.046). However, the incidences of engraftment failure, grade II–IV acute GVHD, relapse, non-relapse mortality (NRM), and GVHD-free relapse-free survival (GRFS) did not differ greatly between groups. In the subgroup analysis, Grafalon improved the OS of lymphoid malignancies with young ages (< 40 years old) (HR, 0.55; P = 0.04) or with a high/very high disease risk index (HR, 0.36; P = 0.04). In the myeloid cohort, Grafalon reduced NRM in the patients who received non-female for male transplantation grafts (HR, 0.17; P = 0.02). Our results suggest the two types of ATG may differentially influence transplant outcomes and it may optimize ATG selection according to the condition of patients.

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Data Availability

The datasets used during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by grants from the National Key Research and Development Program of China (grant no. 2022YFA1103500) and the National Natural Science Foundation of China (grant no. 82170210).

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Authors and Affiliations

  1. Bone Marrow Transplantation Center, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China

    Zhuoyue Shi, Fei Gao, Dang Ding, Hengwei Wu, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Lizhen Liu, Huarui Fu, He Huang & Yanmin Zhao

  2. Liangzhu Laboratory, Hangzhou, Zhejiang, China

    Zhuoyue Shi, Fei Gao, Hengwei Wu, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Lizhen Liu, Huarui Fu, He Huang & Yanmin Zhao

  3. Institute of Hematology, Zhejiang University, Hangzhou, Zhejiang, China

    Zhuoyue Shi, Fei Gao, Hengwei Wu, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Lizhen Liu, Huarui Fu, He Huang & Yanmin Zhao

  4. Zhejiang Province Engineering Research Center for Stem Cell and Immunity Therapy, Hangzhou, Zhejiang, China

    Zhuoyue Shi, Fei Gao, Hengwei Wu, Jimin Shi, Yi Luo, Jian Yu, Xiaoyu Lai, Lizhen Liu, Huarui Fu, He Huang & Yanmin Zhao

  5. Department of Hematology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China

    Yamin Tan

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  1. Zhuoyue Shi
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Contributions

Y-M.Z. and H.H. designed the study, took responsibility for the analyses, and supervised the manuscript preparation. Z-Y.S. and F.G. collected and analyzed the data, and drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the version to be submitted. Z-Y.S. and F.G. contributed equally to the study and should be considered co-first authors.

Corresponding authors

Correspondence to He Huang or Yanmin Zhao.

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The study was approved by the ethics committee of the First Affiliated Hospital of Zhejiang University School of Medicine and in accordance with the Declaration of Helsinki. All patients provided informed consent for retrospective research involving their clinical treatment history.

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The authors declare no conflict of interest.

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Shi, Z., Gao, F., Ding, D. et al. Outcomes of haploidentical peripheral blood stem cell transplantation following myeloablative conditioning using two types of rabbit ATG: a propensity score-matched analysis. Ann Hematol 103, 1353–1362 (2024). https://doi.org/10.1007/s00277-024-05658-3

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