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Comparison of rabbit ATLG and ATG for GVHD prophylaxis in hematological malignancies with haploidentical hematopoietic stem cell transplantation

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Abstract

Rabbit anti-human T lymphocyte globulin (ATLG) and anti-thymocyte globulin (ATG) are commonly used for graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT). Yet, their efficacy and safety have seldom been compared in hematological malignancies with haploidentical HSCT. A retrospective analysis with 28 ATLG (total dosage, 20–30 mg/kg) and 18 ATG (total dosage, 8–10 mg/kg) patients were performed. The cumulative incidences of chronic GVHD and relapse were comparable between both groups. ATLG showed a trend towards a lower acute GVHD incidence (28.6% vs. 44.4%, P = 0.242) and 3-year non-relapse mortality (10.7% vs. 27.8%, P = 0.160), and had a significantly higher 3-year overall survival (OS, 64.3% vs. 33.3%, P = 0.033) and GVHD-free and relapse-free survival (GRFS, 32.1% vs. 11.1%, P = 0.045) compared with ATG. Multivariate Cox regression analysis demonstrated ATLG was independently associated with a favorable OS (hazard ratio [HR] = 0.37, 95% confidence interval [CI]: 0.16–0.86, P = 0.020) and GRFS (HR = 0.51, 95%CI: 0.26-1.00, P = 0.051). Furthermore, ATLG had a lower risk of fever (25.0% vs. 61.1%, P = 0.014) and hemorrhage cystitis (7.1% vs. 38.9%, P = 0.008) than ATG-T. In conclusion, ATLG confers more survival benefit and a better safety profile than ATG and can be used in hematological malignancies with haploidentical HSCT. Prospective designed trials with a larger sample size are warranted to confirm the results in the future.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Author notes

  1. Zhengqin Tian, Qihang Man and Yixin Yang contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China

    Zhengqin Tian, Qihang Man, Yixin Yang, Hexian Guan, Ying Wang, Rongmu Luo & Jingbo Wang

  2. Department of Hematology, China Aerospace Science & Industry Corporation 731 Hospital, Fengtai District, Beijing, 100074, China

    Rongmu Luo

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  1. Zhengqin Tian
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Contributions

RL and JW conceived and designed the study. ZT, QM, YY, HG, and YW collected the data. ZT, QM, and YY analyzed the data and drafted the manuscript. All authors revised the manuscript approved the final version of the manuscript.

Corresponding authors

Correspondence to Rongmu Luo or Jingbo Wang.

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Ethics approval statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of Aerospace Center Hospital, Beijing, China.

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Written informed consent was obtained from the adult patients and the guardians of children patients.

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Tian, Z., Man, Q., Yang, Y. et al. Comparison of rabbit ATLG and ATG for GVHD prophylaxis in hematological malignancies with haploidentical hematopoietic stem cell transplantation. Ann Hematol 103, 1729–1736 (2024). https://doi.org/10.1007/s00277-024-05724-w

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