Comparison of porcine ALG and rabbit ATG on outcomes of HLA-haploidentical hematopoietic stem cell transplantation for patients with acquired aplastic anemia

Abstract

Objective To evaluate the efficacy and safety of P-ALG (porcine anti-lymphocyte globulin) and R-ATG (rabbit anti-thymocyte globulin) in the conditioning regime for patients with acquired aplastic anemia who underwent HLA-haploidentical hematopoietic stem cell transplantation (halpo-HSCT). Methods A total of 91 patients with acquired aplastic anemia who received haplo-HSCT at our center between January 2014 and December 2020 were retrospectively reviewed. Twenty-eight patients were in the P-ALG group while sixty-three patients were in the R-ATG group. Results The median time was 11 versus 13 days (P = 0.294) for myeloid engraftment and 12.5 versus 15 days (P = 0.465) for platelet engraftment in the P-ALG and R-ATG groups, respectively. There were no significant difference in 5-year overall survival (74.83% ± 8.24% vs 72.29% ± 6.26%, P = 0.830), GVHD-free, failure-free survival (71.05% ± 8.65% vs 62.71% ± 6.22%, P = 0.662), failure-free survival (74.83% ± 8.24% vs 66.09% ± 5.84%, P = 0.647) and transplantation-related mortality (25.17% ± 8.24% vs 26.29% ± 6.22%, P = 0.708) between the two groups. The incidence of aGVHD (acute graft versus host disease) (65.39% ± 9.33% vs 62.71% ± 6.30%, P = 0.653), II–IV aGVHD (38.46% ± 9.54% vs 35.64% ± 6.24%, P = 0.695), III–IV aGVHD (19.23% ± 7.73% vs 10.53% ± 4.07%, P = 0.291), cGVHD (chronic graft versus host disease) (22.22% ± 12.25% vs 22.31% ± 6.30%, P = 0.915), and moderate to severe cGVHD (5.56% ± 5.40% vs 9.28% ± 4.46%, P = 0.993) were not significantly different. Similar outcomes were observed between the P-ALG and R-ATG groups for severe bacterial infection (17.9% vs 25.4%, P = 0.431), invasive fungal diseases (3.6% vs 9.5%, P = 0.577) and graft rejection (0% vs 9.5%, P = 0.218). However, the incidence of cytomegalovirus infection and Epstein-Barr virus infection was significantly lower in the P-ALG group (46.4% vs 71.4%, P = 0.022; 3.6% vs 25.4%, P = 0.014). Conclusion The efficacy and safety of P-ALG were similar with R-ATG in the setting of haplo-HSCT for patients with acquired aplastic anemia patients. P-ALG could be an alternative for R-ATG.

Effectiveness of in vivo T‐cell‐depleted regimen containing porcine anti‐lymphocyte globulin or rabbit anti‐thymocyte globulin in preventing acute graft‐versus‐host disease after haploidentical haematopoietic stem cell transplantation

“…Three patients in the p‐ALG 90 mg/kg group and four patients in the r‐ATG group failed to receive neutrophil engraftment due to primary graft failures and subsequently died due to infections. The previous study indicated that patients in the p‐ALG group had a lower incidence of CMV viraemia than the r‐ATG group after halpo‐HSCT 25 . In our study, patients in the group receiving a higher dose of p‐ALG (90 mg/kg) had the highest rates of infection.…”

“…The previous study indicated that patients in the p-ALG group had a lower incidence of CMV viraemia than the r-ATG group after halpo-HSCT. 25 In our study, patients in the group receiving a higher dose of p-ALG (90 mg/kg) had the highest rates of infection. In addition, the incidence of CMV reactivation in the p-ALG 75 mg/kg group was significantly lower than that in the r-ATG group (p = 0.046).…”

“…24 Chen et al reported that the efficacy and safety of p-ALG were comparable with r-ATG for SAA patients receiving haplo-HSCT. 25 Nevertheless, the comparable dosages between different forms of ATG have not been identified yet and depend on the physician's decision.…”

Comparison of characteristics and outcomes on ETP-ALL/LBL and non-ETP ALL patients receiving allogeneic hematopoietic stem cell transplantation

“…Graft versus host disease (GVHD) prophylaxis and supportive care were as described previously ( 19 ).…”

“…The Mount Sinai Acute GVHD International Consortium criteria were used to diagnose and grade acute GVHD (aGVHD) ( 20 ). Cytomegalovirus (CMV) and Epstein–Barr virus (EBV) viremia was defined as before ( 19 ). Severe bacterial infection referred to bacteremia or severe tissue infections.…”