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Prophylactic GvHD treatment with ATLG in patients with myelofibrosis
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Treatment with antithymocyte globulin (ATG) or anti-T-lymphocyte globulin (ATLG) can reduce the incidence and severity of graft-versus-host disease (GvHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) from related or unrelated donors; however, data on the use of ATG/ATLG in patients with myelofibrosis are limited.1 Results from a retrospective analysis to assess the impact of ATLG on outcomes of patients with myelofibrosis undergoing allo-HSCT were published in Bone Marrow Transplantation by Rathje, et al.1 |
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The study found that the cumulative incidence of acute GvHD (aGvHD) Grade II–IV (30% vs 56%; p < 0.001), aGvHD Grade III–IV (20% vs 25%; p = 0.01), and severe chronic GvHD (cGvHD; 7% vs 18%; p = 0.04) was lower in the ATLG cohort (n = 469) vs the no ATLG cohort (n = 238), while the incidences of mild-to-severe cGvHD were similar (49% vs 50%; p = 0.52). |
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ATLG treatment was associated with a notable improvement in the estimated GvHD-free and relapse-free survival (GRFS) at 3 years (53% vs 47%; p = 0.04) and 6 years (45% vs 37%; p = 0.02), particularly in patients with matched related or unrelated donors. |
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Despite the benefits in reducing GvHD and improving GRFS, there were no significant differences between the ATLG and no ATLG cohorts in terms of estimated overall survival at 6 years (64% vs 60%; p = 0.53), cumulative incidences of relapse at 6 years (12% vs 15%; p = 0.62), and non-relapse mortality at 1 year (20% vs 19%; p = 0.80) and 3 years (27% vs 29%; p = 0.55). |
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These findings suggest that ATLG treatment can improve GRFS, mainly driven by a reduction in aGvHD, in patients with myelofibrosis undergoing allo-HSCT with a matched related or unrelated donor. |
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