Advertisement

Impacts of thymoglobulin in patients with acute leukemia in remission undergoing allogeneic HSCT from different donors

Manabu Wakamatsu, Seitaro Terakura, Kazuteru Ohashi, Takahiro Fukuda, Yukiyasu Ozawa, Heiwa Kanamori, Masashi Sawa, Naoyuki Uchida, Shuichi Ota, Akiko Matsushita, Yoshinobu Kanda, Hirohisa Nakamae, Tatsuo Ichinohe, Koji Kato, Makoto Murata, Yoshiko Atsuta and Takanori Teshima on behalf of the GVHD Working Group of the Japan Society for Hematopoietic Cell Transplantation

Data supplements

Article Figures & Data

Figures

Tables

  • Table 1.

    Patient characteristics for each donor type

    CB (n = 1915)MRD (n = 1772)1-MMRD (n = 225)MUD (n = 1742)1-MMUD (n = 963)P
    Age at HSCT, median (range), y44 (0-85)40 (0-74)32 (0-68)45 (0-72)44 (0-71)
     0-20419 (21.9)294 (16.6)75 (33.3)213 (12.2)149 (15.5)<.01
     21-40415 (21.7)618 (34.9)66 (29.3)470 (27.0)258 (26.8)
     41-60667 (34.8)707 (39.9)62 (27.6)754 (43.3)435 (45.1)
     ≥61414 (21.6)153 (8.6)22 (9.8)305 (17.5)121 (12.6)
    Year of HSCT
     2008-2011734 (38.3)848 (47.9)112 (49.8)707 (40.6)373 (38.7)<.01
     2012-20151181 (61.7)924 (52.1)113 (50.2)1035 (59.4)590 (61.3)
    Patient sex
     Male1037 (54.2)1005 (56.7)140 (62.2)984 (56.5)540 (56.1).03
     Female878 (45.8)767 (43.3)85 (37.8)758 (43.5)423 (43.9)
    Disease
     ALL761 (39.7)734 (41.4)93 (41.3)681 (39.1)393 (40.8).66
     AML1154 (60.3)1038 (58.6)132 (58.7)1061 (60.9)570 (59.2)
    Disease status at HSCT
     CR11375 (72.2)1427 (80.7)153 (68.0)1347 (77.5)692 (71.9).01
     ≥CR2530 (27.8)342 (19.3)72 (32.0)392 (22.5)271 (28.1)
     Unknown10 (0.5)3 (0.2)0 (0.0)3 (0.2)0 (0.0)<.01
    ECOG-PS
     0-21801 (94.0)1711 (96.6)211 (93.8)1678 (96.3)917 (95.2)<.01
     3-4104 (5.5)57 (3.2)14 (6.2)60 (3.5)46 (4.8)
     Unknown10 (0.5)4 (0.2)0 (0.0)4 (0.2)0 (0.0)
    Donor source
     BM808 (45.6)110 (48.9)1699 (97.5)961 (99.8)<.01
     PB964 (54.4)115 (51.1)43 (2.5)2 (0.2)
    HLA disparity
     Match251 (13.1)17721742
     Mismatch1664 (86.9)225963
    Conditioning regimen
     Myeloablative1111 (58.0)1326 (74.8)149 (66.2)1145 (65.7)640 (66.5)<.01
     BU/TBI based188/923302/102441/108263/882131/509
     Reduced intensity801 (41.8)445 (25.1)76 (33.8)594 (34.1)323 (33.5)
     Unknown3 (0.2)1 (0.1)0 (0.0)3 (0.2)0 (0.0)
    GVHD prophylaxis
     Tac based1347 (70.3)330 (18.6)187 (83.1)1484 (85.2)868 (90.2)<.01
     CyA based553 (28.9)1405 (79.3)34 (15.1)236 (13.6)83 (8.6)
     Others/unknown15 (0.8)37 (2.1)4 (1.8)22 (1.2)12 (1.2)
    Use of ATG
     ATG(−)1862 (97.2)1754 (99.0)153 (68.0)1709 (98.1)860 (89.3)<.01
     ATG(+)53 (2.8)18 (1.0)72 (32.0)33 (1.9)103 (10.7)
    • Data are presented as n (%), unless otherwise indicated.

    • —, not applicable; BU, busulfan; CyA, cyclosporin A; TBI, total body irradiation; Tac, tacrolimus.

  • Table 2.

    Multivariate analysis of the clinical impact of ATG in each donor type

    CBMRD1-MMRDMUD1-MMUD
    nHR (95% CI)PnHR (95% CI)PnHR (95% CI)PnHR (95% CI)PnHR (95% CI)P
    Neutrophil engraftment
     ATG(−)18621175411531170918601
     ATG(+)531.213 (0.833-1.765).31180.919 (0.659-1.281).62721.083 (0.802-1.462).60330.946 (0.671-1.332).751031.115 (0.920-1.351).27
    Platelet engraftment
     ATG(−)18621175411531170918601
     ATG(+)530.987 (0.699-1.393).94180.882 (0.502-1.549).66721.087 (0.809-1.460).58330.893 (0.570-1.400).621030.898 (0.716-1.126).35
    Grades II to IV aGVHD
     ATG(−)18621175411531170918601
     ATG(+)530.900 (0.543-1.494).68180.163 (0.022-1.205).08720.552 (0.352-0.863)<.01330.712 (0.368-1.378).311030.576 (0.399-0.832)<.01
    Extensive cGVHD
     ATG(−)16271168311441159117741
     ATG(+)410.455 (0.112-1.852).27160.210 (0.029-1.502).12620.517 (0.262-1.022).06291.326 (0.589-2.983).50930.460 (0.244-0.869).02
    NRM
     ATG(−)18621175411531170918601
     ATG(+)531.608 (1.048-2.468).03181.161 (0.271-4.966).84720.764 (0.383-1.525).45331.475 (0.702-3.101).301030.545 (0.315-0.944).03
    RI
     ATG(−)18621175411531170918601
     ATG(+)531.023 (0.527-1.988).95182.026 (0.968-4.242).06721.216 (0.579-2.555).61331.206 (0.572-2.545).621030.773 (0.410-1.459).43
    OS
     ATG(−)18621175411531170918601
     ATG(+)531.403 (0.991-2.145).054182.092 (1.033-4.237).04720.867 (0.526-1.430).58331.358 (0.763-2.417).301030.673 (0.438-1.033).07
    • 95% CI, 95% confidence interval.

  • Table 3.

    Multivariate analysis of risk factors for GRFS

    VariablesCBMRD1-MMRDMUD1-MMUD
    HR (95% CI)PHR (95% CI)PHR (95% CI)PHR (95% CI)PHR (95% CI)P
    Use of ATG*
     ATG(−)11111
     ATG(+)1.458 (0.995-1.979).0530.990 (0.530-1.851).950.915 (0.634-1.322).641.360 (0.870-2.125).180.515 (0.361-0.734)<.01
    Age at HSCT, y
     0-201111
     21-401.373 (1.114-1.693)<.01
     41-601.481 (1.225-1.790)<.011.398 (1.132-1.727)<.011.677 (1.318-2.135)<.01
     ≥611.906 (1.558-2.331)<.011.690 (1.284-2.224)<.011.927 (1.121-3.313)01.899 (1.417-2.545)<.01
    Disease status at HSCT
     CR111
     ≥CR21.174 (1.002-1.374).051.265 (1.051-1.524).01
    Donor source
     BM1<.01
     PB1.339 (1.170-1.532)
    ECOG-PS
     0-21
     3-41.820 (1.338-2.476)<.01
    HLA disparity
     Match1
     Mismatch1.233 (1.003-1.515).046
    Sex
     Male11
     Female0.832 (0.731-0.948)<.010.777 (0.678-0.889)<.01
    • —, HR was not shown because the data was not significant.

    • * Use of ATG was presented as variables of interest.

    • HLA 1- or 2-antigen–mismatched CB.