EHA 2019 | Should we use PTCy or ATG as GvHD prophylaxis in haploidentical stem cell transplantation?

At the 24th Congress of the European Hematology Association (EHA), Arnon Nagler from the Tel Aviv University, Tel Aviv, IL, discusses whether prophylactic post-transplant cyclophosphamide (PTCy) or anti-thymocyte globulin (ATG) provides a better outcome for patients with acute myeloid leukemia (AML) who are at risk of developing graft-versus-host disease (GvHD).

Professor Nagler discusses GvHD prophylaxis in haploidentical stem cell transplant (haplo-SCT), noting two main strategies; using ATG or using PTCy. In trials in patients with AML, based on the EBMT registry, PTCy improved overall survival, leukemia-free survival and GvHD-relapse free survival benefit compared to ATG. In a recent study, the group looked at outcomes of patients with acute lymphoblastic leukemia (ALL), also finding a benefit of PTCy over ATG in haplo-SCT.

Professor Nagler concluded there is more and more data in the European population that PTCy is better for prevention of GvHD compared to ATG. However, a two-arm study would be necessary to prove this.