Improved GVHD-free relapse-free survival when rATG/ATLG is used in allo-HCT from matched sibling donors - an EBMT registry study by the Transplant Complications Working Party

Piekarska A, Abouqateb M, Boreland W, Peczynski C, Zaucha JM, Kröger N, Zeiser R, Ciceri F, Schroeder T, Luft T, Passweg J, Kunadt D, Stelljes M, Blau IW, Platzbecker U, Yakoub-Agha I, Blaise D, Raiola AM, Tischer J, Wagner-Drouet EM, Winkler J, Schmid C, Wulf G, Edinger M, Maertens J, Stölzel F, Vydra J, Zak P, Moiseev I, Schoemans H, Penack O, Peric Z (2025)

Publication Language: English

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 60

Pages Range: 1574-1583

DOI: 10.1038/s41409-025-02692-1

Abstract

The EBMT recommends rabbit anti-thymocyte or anti-T-lymphocyte globulin (rATG/ATLG) as GVHD prophylaxis in matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). However, discrepancies between recommendations and clinical practice were reflected in the EBMT survey. Therefore, we performed retrospective EBMT registry analysis from 2014 to 2021 to reinforce the real-world evidence context of rATG/ATLG impact on post-transplantation outcomes. This study included 11,420 adult patients (non-ATG n = 7680 and ATG n = 3740) with hematological malignancies after the first allo-HCT from peripheral blood. Use of ATG was associated with a reduced risk of aGVHD II-IV (Day +100: non-ATG vs ATG, 27.6% vs. 21.6%; adjusted HR 0.7, p < 0.001) and cGVHD (2-year: non-ATG vs ATG, 48.9% vs 30%; adjusted HR 0.45, p < 0.001), improved OS (2-year: 62.9% vs 63.3%; adjusted HR 0.89, p = 0.009), reduced NRM (2-year: 16% vs 12.5%; adjusted HR 0.63, p < 0.001), and higher GRFS (2-year: 32.2% vs 40.7%; adjusted HR 0.72, p < 0.001). While RI was higher in the ATG group (2-year: non-ATG vs ATG, 30.2% vs 34.7%; adjusted HR 1.22, p < 0.001) it did not translate into a significantly lower PFS (2-year: 53.9% vs 52.8%; adjusted HR not significant). Overall, outcomes were favorable for the intermediate rATG/ATLG dose ranges compared to the low and high dose ranges. Administration of rATG/ATLG improved outcomes in MSD allo-HCT recipients, supporting the EBMT recommendation for its use.

Authors with CRIS profile

Involved external institutions

Universitätsklinikum Leipzig Germany (DE) Institute of Hematology and Blood Transfusion (IHBT) / Ústav hematologie a krevní transfuze (ÚHKT) Czech Republic (CZ) Medical University Gdansk / Gdański Uniwersytet Medyczny Poland (PL) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) Charité - Universitätsmedizin Berlin Germany (DE) Clinical Hospital Center Rijeka / Klinički bolnički centar Rijeka Croatia (HR) Hôpital Saint-Antoine France (FR) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Freiburg Germany (DE) Ospedale San Raffaele (früher: Centro San Raffaele del Monte Tabor Foundation) Italy (IT) Universitätsklinikum Essen Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE) Universitätsspital Basel Switzerland (CH) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Westfälische Wilhelms-Universität (WWU) Münster Germany (DE) Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille) France (FR) Aix-Marseille University / Aix-Marseille Université France (FR) Universität Regensburg Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Univerzita Karlova v Praze / Charles University in Prague Czech Republic (CZ) First Pavlov State Medical University of St. Petersburg Russian Federation (RU) Ospedale Policlinico San Martino Italy (IT) Klinikum der Universität München (LMU Klinikum) Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Universitätsklinikum Augsburg Germany (DE) Universitätsklinikum Göttingen Germany (DE)

How to cite

APA:

Piekarska, A., Abouqateb, M., Boreland, W., Peczynski, C., Zaucha, J.M., Kröger, N.,... Peric, Z. (2025). Improved GVHD-free relapse-free survival when rATG/ATLG is used in allo-HCT from matched sibling donors - an EBMT registry study by the Transplant Complications Working Party. Bone Marrow Transplantation, 60, 1574-1583. https://doi.org/10.1038/s41409-025-02692-1

MLA:

Piekarska, Agnieszka, et al. "Improved GVHD-free relapse-free survival when rATG/ATLG is used in allo-HCT from matched sibling donors - an EBMT registry study by the Transplant Complications Working Party." Bone Marrow Transplantation 60 (2025): 1574-1583.

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