1. Planned Granulocyte Colony-Stimulating Factor Adversely Impacts Survival after Allogeneic Hematopoietic Cell Transplantation Performed with Thymoglobulin for Myeloid Malignancy.
- Author
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Orfali, N, Zhang, M-J, Allbee-Johnson, M, Boelens, JJ, Artz, AS, Brunstein, CG, McNiece, IK, Milano, F, Abid, MB, Chee, L, Diaz, MA, Grunwald, MR, Hematti, P, Hsu, J, Lazarus, HM, Munshi, PN, Prestidge, T, Ringden, O, Rizzieri, D, Riches, ML, Seo, S, Solh, M, Solomon, S, Szwajcer, D, Yared, J, van Besien, K, Eapen, M, Orfali, N, Zhang, M-J, Allbee-Johnson, M, Boelens, JJ, Artz, AS, Brunstein, CG, McNiece, IK, Milano, F, Abid, MB, Chee, L, Diaz, MA, Grunwald, MR, Hematti, P, Hsu, J, Lazarus, HM, Munshi, PN, Prestidge, T, Ringden, O, Rizzieri, D, Riches, ML, Seo, S, Solh, M, Solomon, S, Szwajcer, D, Yared, J, van Besien, K, and Eapen, M
- Abstract
The in vivo depletion of recipient and donor T lymphocytes using antithymocyte globulin (ATG; Thymoglobulin) is widely adopted in allogeneic hematopoietic stem cell transplantation (HCT) to reduce the incidence of both graft failure and graft-versus-host disease (GVHD). However, excess toxicity to donor lymphocytes may hamper immune reconstitution, compromising antitumor effects and increasing infection. Granulocyte-colony stimulating factor (G-CSF) administered early after HCT may increase ATG-mediated lymphotoxicity. This study aimed to investigate the effect of an interaction between ATG and post-transplantation granulocyte colony-stimulating factor (G-CSF) on allogeneic HCT outcomes, using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry. We studied patients age ≥18 years with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) who received Thymoglobulin-containing preparative regimens for HLA-matched sibling/unrelated or mismatched unrelated donor HCT between 2010 and 2018. The effect of planned G-CSF that was started between pretransplantation day 3 and post-transplantation day 12 was studied in comparison with transplantations that did not include G-CSF. Cox regression models were built to identify risk factors associated with outcomes at 1 year after transplantation. A total of 874 patients met the study eligibility criteria, of whom 459 (53%) received planned G-CSF. HCT with planned G-CSF was associated with a significantly increased risk for nonrelapse mortality (NRM) (hazard ratio [HR] 2.03; P <.0001; 21% versus 12%) compared to HCT without G-CSF. The 6-month incidence of viral infection was higher with G-CSF (56% versus 47%; P = .007), with a particular increase in Epstein-Barr virus infections (19% versus 11%; P = .002). The observed higher NRM with planned G-CSF led to lower overall survival (HR, 1.52; P = .0005; 61% versus 72%). There was no difference in GVHD risk between the treatment groups. We per
- Published
- 2021