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EBMT 2022 | ATG vs PTCy in ALL following MUD HSCT

Anti-thymocyte globulin (ATG) is currently the standard of care (SOC) treatment for patients with acute lymphoblastic leukemia (ALL) who have undergone matched unrelated donor (MUD) hematopoietic stem cell transplantation (HSCT). In this video, Sebastian Giebel, MD, PhD, Maria Sklodowska-Curie Institute – Oncology Center, Gliwice, Poland, outlines the results of a retrospective study comparing the outcomes of patients with ALL treated with ATG or post-transplant cyclophosphamide (PTCy). Overall, the study found that the use of ATG was associated with an increased risk of relapse and reduced leukemia-free survival, suggesting that PTCy should replace the current SOC. It is necessary to confirm these findings in a prospective trial. This interview took place at the 48th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2022, which was held virtually.

Transcript (edited for clarity)

In matched unrelated donor hematopoietic cell transplantation setting, the use of anti-thymocyte globulin is currently a standard of care. However, in acute lymphoblastic leukemia, we demonstrated in our retrospective analysis that the use of ATG was associated with increased risk of relapse. Now we have an alternative, which is post-transplant cyclophosphamide, more and more popular across European and worldwide centers, and this also used the context of MUD for ALL patients...

In matched unrelated donor hematopoietic cell transplantation setting, the use of anti-thymocyte globulin is currently a standard of care. However, in acute lymphoblastic leukemia, we demonstrated in our retrospective analysis that the use of ATG was associated with increased risk of relapse. Now we have an alternative, which is post-transplant cyclophosphamide, more and more popular across European and worldwide centers, and this also used the context of MUD for ALL patients. So in our study, we compare these two approaches, ATG versus post-transplant cyclophosphamide for ALL patients with good a MUD HCT. In the unified analysis, we found that the use of ATG was associated with an increased risk of relapse and a reduced probability of leukemia-free survival. In the multivariate model, adjusted for other prognostic factors, we confirmed the effect on leukemia risk, leukemia-free survival, which was reduced from patients who took ATG compared to PTCy.
So altogether, although the study was retrospective, we think it is justified to recommend PTCy as the backbone of immune suppression for patients treated with MUD HCT with ALL and first complete remission. Obviously, our findings require verification in prospective trials.

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Disclosures

Novartis (speaker’s bureau, consultation fees), Gilead (speaker’s bureau, consultation fees), Angelini (speaker’s bureau, consultation fees, research support), Amgen (speaker’s bureau, consultation fees), Pfizer (speaker’s bureau, consultation fees)