Comparison of immune reconstitution between anti-T-lymphocyte globulin and post-transplant cyclophosphamide as acute graft-versus-host disease prophylaxis in allogeneic myeloablative peripheral blood stem cell transplantation

Haematologica. 2021 Apr 8. doi: 10.3324/haematol.2020.271445. Online ahead of print.ABSTRACTAnti T-cell lymphocyte globulin (ATLG) and post-transplant cyclophosphamide (PTCy) are now widely used strategies to prevent graft-versus-host disease after allogeneic stem cell transplantation. Data comparing immune reconstitution (IR) between ATLG and PTCy is scarce. This retrospective study conducted at the University Medical-Center Hamburg- Eppendorf (UKE) compares after myeloablative PBSC allogeneic stem cell transplant between PTCy (n=123) and ATLG (n=476). Detailed phenotypes of T, B natural killer (NK), natural killer T (NKT) cells were analyzed by multicolor flow at day 30, 100 and 180 posttransplant. Incidence of infections, viral reactivations graft-versus-host disease and relapse were collected. Neutrophil engraftment was significantly delayed in the PTCy group (median day 12 vs. 10, p < 0.001) with a high incidence of infection before day+100 in the PTCy arm but a higher EBV reactivation in the ATLG arm and comparable CMV reactivation. Overall incidence of acute GVHD was similar but moderate/severe chronic GVHD was more seen after PTCy (44% vs. 38%, p = 0.005). ATLG resulted in a faster reconstitution of CD8+ T-cells, NK cells, NKT cells, and γδT cells while CD4 T-cells and B-cells reconstituted faster after PTCy. Similar reconstitution was observed for T-regulatory cells and B-cells. NRM, relapse incidence, DFS, and overall survival did not differ significantly betwe...
Source: Haematologica - Category: Hematology Authors: Source Type: research