EBMT 2022 | Low-dose ATG in combination with PTCy in alloHSCT & biomarkers for GvHD
Raffaella Greco, MD, PhD, San Raffaele Hospital, Milan, Italy, discusses the possible use of low-dose anti-thymocyte globulin (ATG) in the context of allogeneic hematopoietic stem cell transplantation (alloHSCT) with post-transplant cyclophosphamide (alloHSCT). Although it has been suggested that low-dose ATG can lead to a lower incidence of chronic graft-versus-host disease (cGvHD), further studies with a higher number of patients need be conducted to validate these results. Moving forward, Dr Greco talks on the importance of identifying patients at a higher risk of developing GvHD prior to alloHSCT using biomarkers. Several ongoing studies have been exploring the best biomarkers for predicting the risk of GvHD in alloHSCT recipients. 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)
Regarding the possible use of low-dose ATG in the context of post-transplant cyclophosphamide transplantation, I think that as we have seen in our self-experience, we can have less rate of chronic GvHD, but there are some issues. For example, regarding some pro-graft function cases that still need to be well addressed. So I think that we need more numbers, we need multicenter trials, and we need probably different cases to draw any exact conclusion regarding this possible addition...
Regarding the possible use of low-dose ATG in the context of post-transplant cyclophosphamide transplantation, I think that as we have seen in our self-experience, we can have less rate of chronic GvHD, but there are some issues. For example, regarding some pro-graft function cases that still need to be well addressed. So I think that we need more numbers, we need multicenter trials, and we need probably different cases to draw any exact conclusion regarding this possible addition. It is important to underline that we have used to have ATG in this context, based on the CD3 positive content, higher in the graft of our patient. But nowadays we know that we can have different and more specific biomarkers trying to predict the risk of GvHD in our patients that we cannot have really in the clinical practice easily nowadays. But I hope that we can have for the future, for example, in our center, but also in other centers, we have other biomarkers that have been investigated. We have also performed an experience with interleukin-6 with the microbiome, and there are also other studies ongoing all over the world, trying to identify the best biomarker. For example, the MAGIC consortium. I think that really for the future, we need to better identify which patients are at higher risk for GvHD in the context of allogeneic stem cell transplantation from the beginning. And then trying to make a certification, and give immunosuppression according to the risk of GvHD of each patient. Maybe an individualized and personalized approach can be better for the future to have good results.
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