TY - JOUR

T1 - Impact of T-cell depletion strategies on outcomes following hematopoietic stem cell transplantation for idiopathic aplastic anemia

T2 - A study on behalf of the European blood and marrow transplant severe aplastic anemia working party

AU - Samarasinghe, Sujith

AU - Clesham, Katherine

AU - Iacobelli, Simona

AU - Sbianchi, Giulia

AU - Knol, Cora

AU - Hamladji, Rose-Marie

AU - Socié, Gerard

AU - Aljurf, Mahmoud

AU - Koh, Mickey

AU - Sengeloev, Henrik

AU - Dalle, Jean-Hugues

AU - Robinson, Stephen

AU - Van Lint, Maria Teresa

AU - Halkes, Constantijn J M

AU - Beelen, Dietrich

AU - Mufti, Ghulam J

AU - Snowden, John

AU - Blaise, Didier

AU - de Latour, Regis Peffault

AU - Marsh, Judith

AU - Dufour, Carlo

AU - Risitano, Antonio M

AU - Severe Aplastic Anaemia Working Party of the EBMT

PY - 2019

Y1 - 2019

N2 - We retrospectively analyzed the outcomes of 1837 adults and children with severe aplastic anemia (SAA) who underwent matched sibling donor (MSD) and matched unrelated donor (MUD) hemopoietic stem cell transplantation (HSCT) between 2000 and 2013. Patients were grouped by transplant conditioning containing either anti-thymocyte globulin (ATG) (n = 1283), alemtuzumab (n = 261), or no serotherapy (NS) (n = 293). The risks of chronic GvHD were significantly reduced when ATG or alemtuzumab were compared with NS (P = .021 and .003, respectively). Acute GVHD was significantly reduced in favor of alemtuzumab compared with ATG (P = .012) and NS (P < .001). By multivariate analysis, when compared with ATG, alemtuzumab was associated with a lower risk of developing acute (OR 0.262; 95% CI 0.14-0.47; P < .001) and chronic GVHD (HR 0.58; 95% CI 0.35-0.94; P = .027). OS was significantly better in ATG and alemtuzumab patients compared with NS (P = .010 and .025). Our data shows inclusion of serotherapy in MSD and MUD HSCT for patients with SAA reduces chronic GVHD and provides a survival advantage over patients not receiving serotherapy. Notably, alemtuzumab reduced the risk of acute and chronic GvHD compared with ATG and indicates that alemtuzumab might be the serotherapy of choice for MSD and MUD transplants for SAA.

AB - We retrospectively analyzed the outcomes of 1837 adults and children with severe aplastic anemia (SAA) who underwent matched sibling donor (MSD) and matched unrelated donor (MUD) hemopoietic stem cell transplantation (HSCT) between 2000 and 2013. Patients were grouped by transplant conditioning containing either anti-thymocyte globulin (ATG) (n = 1283), alemtuzumab (n = 261), or no serotherapy (NS) (n = 293). The risks of chronic GvHD were significantly reduced when ATG or alemtuzumab were compared with NS (P = .021 and .003, respectively). Acute GVHD was significantly reduced in favor of alemtuzumab compared with ATG (P = .012) and NS (P < .001). By multivariate analysis, when compared with ATG, alemtuzumab was associated with a lower risk of developing acute (OR 0.262; 95% CI 0.14-0.47; P < .001) and chronic GVHD (HR 0.58; 95% CI 0.35-0.94; P = .027). OS was significantly better in ATG and alemtuzumab patients compared with NS (P = .010 and .025). Our data shows inclusion of serotherapy in MSD and MUD HSCT for patients with SAA reduces chronic GVHD and provides a survival advantage over patients not receiving serotherapy. Notably, alemtuzumab reduced the risk of acute and chronic GvHD compared with ATG and indicates that alemtuzumab might be the serotherapy of choice for MSD and MUD transplants for SAA.

U2 - 10.1002/ajh.25314

DO - 10.1002/ajh.25314

M3 - Journal article

C2 - 30328134

VL - 94

SP - 80

EP - 86

JO - American Journal of Hematology

JF - American Journal of Hematology

SN - 0361-8609

IS - 1

ER -