Posttransplant cyclophosphamide versus antithymocyte globulin in patients with cardiovascular comorbidity undergoing allogeneic hematopoietic cell transplantation for acute myeloid leukaemia in first complete remission from unrelated donors: a retrospective matched-pair analysis from the ALWP of the EBMT

TL;DR

This study compares two treatments for preventing transplant complications in patients with heart-related health issues and finds similar long-term outcomes.

Contribution

The study provides evidence that posttransplant cyclophosphamide is as effective as antithymocyte globulin in patients with cardiovascular comorbidities.

Findings

Overall survival at 2 years was 67.5% for ATG and 68.6% for ptCy.

Non-relapse mortality was lower in the ptCy group compared to the ATG group.

Relapse incidence and leukemia-free survival were comparable between the two groups.

Abstract

We retrospectively analyzed data from the EBMT registry on patients with pretransplant comorbidities associated with cardiovascular risk. Patients who underwent first allogeneic hematopoietic cell transplantation for acute myeloid leukemia in first complete remission between 2010 and 2022 from unrelated donors using post-transplant cyclophosphamide (ptCy) or anti-thymocyte globulin (ATG)-based graft-versus-host disease prophylaxis with a history of cardiac disease, arrhythmia, diabetes, obesity or cerebrovascular disease according to the HCT-specific comorbidity index were included. We performed a matched-pair analysis using a propensity score. After matching, 432 patients were included: 313 in the ATG group and 119 in the ptCy group. At 2 years, overall survival was 67.5% (95% CI 61–73.2) and 68.6% (95% CI 56.7–77.8); leukemia-free survival was 60.4% (95% CI 53.8–66.4) and 62.6% (95% CI 50.4–72.6); relapse incidence was 22.1% (95% CI 17–27.7) and 23.2% (95% CI 14.3–33.4); non-relapse mortality was 17.5% (95% CI 13.1–22.4) and 14.1% (95% CI 7.5–22.8), respectively. In conclusion, our study suggests that the use of ptCY for GVHD prophylaxis in patients with preexisting comorbidities associated with cardiovascular risk yields long-term outcomes comparable to those observed with ATG-based approaches.

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