Long-term outcomes after standard graft-versus-host disease prophylaxis with or without anti-human-T-lymphocyte immunoglobulin in haemopoietic cell transplantation from matched unrelated donors: final results of a randomised controlled trial

Finke, Juergen; Schmoor, Claudia; Bethge, Wolfgang; Ottinger, Hellmut; Stelljes, Matthias; Volin, Liisa; Heim, Dominik; Bertz, Hartmut; Grishina, Olga; Socié, Gèrard

doi:10.1016/s2352-3026(17)30081-9

Cited by 86 publications

(64 citation statements)

References 23 publications

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“…The reduction of the cGVHD rate translated into a reduced risk of NRM, mainly because of fewer GVHD‐related deaths among patients treated with ATG, whereas the infection rate was higher. Indeed, previous reports also indicated higher rates of infections, particularly viral infections (Epstein‐Barr virus and CMV) associated with the use of ATG …”

Section: Discussionmentioning

confidence: 93%

“…Five randomized studies have addressed the impact of ATG on the results of allo‐SCT, mainly in patients with acute myeloid leukemia (AML). Four of the studies included unrelated donors . The first study by Bacigalupo et al focused only on bone marrow as a source of stem cells.…”

Section: Discussionmentioning

confidence: 99%

“…Data reported so far regarding the use of ATG in patients undergoing allo‐SCT from both human leukocyte antigen–matched sibling and unrelated donors with myeloablative conditioning (MAC) or reduced‐intensity conditioning (RIC) indicate that ATG may provide a benefit, especially in terms of reducing the incidence of cGVHD . However, the prospective, randomized studies published so far have included heterogeneous patient populations, with the vast majority diagnosed with myeloid malignancies . The available data for patients with Ph‐neg ALL is rather limited.…”

Section: Introductionmentioning

confidence: 99%

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Anti‐thymocyte globulin improves survival free from relapse and graft‐versus‐host disease after allogeneic peripheral blood stem cell transplantation in patients with Philadelphia‐negative acute lymphoblastic leukemia: An analysis by the Acute Leukemia Working Party of the EBMT

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Labopin

Giebel

et al. 2018

Cancer

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anti‐thymocyte globulin improves survival free from relapse and graft‐versus‐host disease after allogeneic peripheral blood stem cell transplantation in patients with Philadelphia‐negative acute lymphoblastic leukemia: An analysis by the Acute Leukemia Working Party of the EBMT

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Labopin

Giebel

et al. 2018

Cancer

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“…With regards to this endpoint, time-dependent effects for disease stage, year of transplantation (2006–2013), conditioning intensity and a poor KPS were detected. 21,22 For disease stage, a considerably higher risk of death from other causes was observed in the first 10 months after transplantation, which reflects the higher incidence of relapse in patients in late disease stage. 23 This is consistent with the results for relapse incidence within the composite endpoint of disease-free survival.…”

Section: Discussionmentioning

confidence: 99%

Competing-risk outcomes after hematopoietic stem cell transplantation from the perspective of time-dependent effects

et al. 2018

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The success of hematopoietic stem cell transplantation is determined by multiple factors. Additional complexity is conferred by covariables showing time-dependent effects. We evaluated the effect of predictors on competing-risk outcomes after hematopoietic stem cell transplantation in a time-dependent manner. We analyzed 14951 outcomes of adult patients with hematologic malignancies who underwent a first allogeneic transplant. We extended the combined endpoints of disease-free and overall survival to competing-risk settings: disease-free survival was split into relapse and non-relapse mortality. Overall survival was divided into transplant-related mortality, death from other causes and death from unknown causes. For time-dependent effects we computed estimators before and after a covariable-specific cut-point. Patients treated with reduced intensity conditioning had a constantly higher risk of relapse compared to patients treated with myeloablative conditioning. For non-relapse mortality, patients treated with reduced intensity conditioning had a reduced mortality risk but this effect was only seen in the first 4 months after transplantation (hazard ratio: 0.76, P<0.001) and not afterwards. Graft source exhibited a time-dependent effect on both transplant-related mortality (in first year: hazard ratio 0.70, P<0.001; after first year: hazard ratio 1.47, P=0.002) and non-relapse mortality (in first 8 months: hazard ratio 0.75, P<0.001; after first 8 months: hazard ratio 1.38, P<0.001). Patients with a poor Karnofsky performance score (<80) had a considerably higher risk of all endpoints in the first 4 months. The competing-risk analysis for overall survival and disease-free survival allows resolution of effects with different vectors early and later after stem cell transplantation, as shown for graft source. This information may be useful in risk assessment of treatment choices and for counseling patients on an individual basis.

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“…The Lancet Haematology, Finke and colleagues 7 report the final results of a randomised phase 3 multicentre trial (previously reported after a median follow-up of 2 years 8 ) comparing standard GVHD prophylaxis with ciclosporine and methotrexate with or without additional ATLG (60 mg/kg total dose) in patients given grafts (mainly peripheral blood stem-cells) from unrelated donors. Median follow-up was 8·6 years.…”

Section: Unrelated Donor Haemopoietic Stem-cell Transplantation: Atg mentioning

confidence: 99%

Unrelated donor haemopoietic stem-cell transplantation: ATG or not?

Baron

2017

The Lancet Haematology

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Long-term outcomes after standard graft-versus-host disease prophylaxis with or without anti-human-T-lymphocyte immunoglobulin in haemopoietic cell transplantation from matched unrelated donors: final results of a randomised controlled trial

Cited by 86 publications

References 23 publications

Anti‐thymocyte globulin improves survival free from relapse and graft‐versus‐host disease after allogeneic peripheral blood stem cell transplantation in patients with Philadelphia‐negative acute lymphoblastic leukemia: An analysis by the Acute Leukemia Working Party of the EBMT

Anti‐thymocyte globulin improves survival free from relapse and graft‐versus‐host disease after allogeneic peripheral blood stem cell transplantation in patients with Philadelphia‐negative acute lymphoblastic leukemia: An analysis by the Acute Leukemia Working Party of the EBMT

Competing-risk outcomes after hematopoietic stem cell transplantation from the perspective of time-dependent effects

Unrelated donor haemopoietic stem-cell transplantation: ATG or not?

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