Antithymocyte globulin following non-MSDT improves survival in MDS patients
Antithymocyte globulin (ATG) is associated with improved survival and a lower rate of nonrelapse morbidity (NRM) in patients with myelodysplastic syndromes (MDS) receiving non-matched sibling donor transplant (MSDT), a new study reveals.
The study retrospectively investigated the data of 85 patients with MDS who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). Endpoints of the study were overall survival (OS), overall survival post-transplant (OSPT), NRM and relapse.
A hundred days after transplantation, 28 patients (35.9 percent) developed grades I-II of acute graft-versus-host disease (GVHD), while 15 patients (19.2 percent) developed grades III-IV. Moreover, 69.4 percent of patients with evaluable infections had bacterial or fungal infections. The most common infection was pneumonia.
Of the 85 patients, 16 (18.8 percent) had relapses. The cumulative incidence of relapses was 14, 23 and 27 percent during the first, second and third years, respectively. There was no significant difference in relapse incidence between MSDT and non-MSDT patients (p=0.932).
Furthermore, ATG involvement in the regimen did not affect the risk of relapse after transplant. Intensive chemotherapy or decitabine therapy also did not influence the risk of relapse compared to supportive pre-HSCT care (p=0.107).
A total of 38 patients died; 30 deaths were caused by NRM. The cumulative incidences of NRM was 13, 23 and 28 percent during the first, second and third years. Compared to non-MSDT patients, NRM was higher in MSDT patients. The ATG cohort also showed significantly fewer NRM cases (p=0.03).
OS during the first, second and fifth years was 63, 57 and 48 percent, respectively. OSPT probabilities were 58, 55 and 48 percent for the first, second and fifth years, respectively.
Finally, the median OSPT in non-MSDT patients was significantly better than in MSDT patients (p=0.042), while using ATG improved OS (p=0.016) and OSPT (p=0.025) after non-MSDT.