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Disease-specific impact of anti-thymocyte globulin in allogeneic hematopoietic cell transplantation: a nationwide retrospective study on behalf of the JSTCT, transplant complications working group

Bone Marrow Transplantation volume 57, pages 479–486 (2022)Cite this article

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Abstract

The disease-specific impact of anti-thymocyte globulin (ATG) in allogeneic hematopoietic cell transplantation (allo-HCT) has not been determined. We retrospectively assessed the impact of ATG in allo-HCT using nationwide registry data from the Japan Society for Transplantation and Cellular Therapy. We included patients who received their first allo-HCT between 2007 and 2018 for acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or malignant lymphoma (ML). In total, 8747 patients were included: 7635 patients did not receive ATG and 1112 patients received ATG as GVHD prophylaxis. The median follow-up period of surviving patients was 1457 days. There was no significant impact of pretransplant ATG on the OS or NRM rates in patients with ALL, AML, or ML. In patients with MDS, the probability of 3-year OS was 53.3% in the non-ATG group and 64.2% in the ATG group (P = 0.001). The cumulative incidence rates of relapse and NRM at 3 years were 14.2% and 30.3% (95% CI 27.2–33.3%), respectively, in the non-ATG group and 17.1% and 18.1% in the ATG group (P = 0.15 and P < 0.001). The same finding was observed in a propensity-score matched cohort. Our study suggests that the clinical benefit of ATG could vary among hematological diseases.

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Fig. 1: Clinical outcome stratified according to the use of ATG.
Fig. 2: Clinical outcome in patients with MDS stratified according to the use of ATG.
Fig. 3: Clinical outcome in patients with MDS in a propensity-matched cohort stratified according to the use of ATG.

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Acknowledgements

This study was partly supported by Health, Labor and Welfare Sciences Research Grants (20FF1002).

Author information

Authors and Affiliations

  1. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Shigeo Fuji

  2. Department of Hematology and Oncology, St. Marianna University School of Medicine, Kanagawa, Japan

    Tsuneaki Hirakawa

  3. Department of Medical Oncology and Hematology, Oita University Faculty of Medicine, Oita, Japan

    Kuniko Takano

  4. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    Noriko Doki

  5. Department of Hematology and Oncology, Anjo Kosei Hospital, Aichi, Japan

    Masashi Sawa

  6. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan

    Yoshinobu Kanda & Hideki Nakasone

  7. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

    Naoyuki Uchida

  8. Department of Hematology, Hokkaido University Hospital, Hokkaido, Japan

    Takahide Ara

  9. Hematology, Oncology & Cardiovascular medicine, Kyushu University Hospital, Fukuoka, Japan

    Toshihiro Miyamoto

  10. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    Tetsuya Eto

  11. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

    Ken-ichi Matsuoka

  12. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Toshiro Kawakita

  13. Department of Hematology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan

    Yukiyasu Ozawa

  14. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan

    Yuta Katayama

  15. Department of Hematology/Oncology, Tokai University School of Medicine, Kanagawa, Japan

    Makoto Onizuka

  16. Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan

    Takahiro Fukuda

  17. Japanese Data Center for Hematopoietic Cell Transplantation, Aichi, Japan

    Yoshiko Atsuta

  18. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Aichi, Japan

    Yoshiko Atsuta

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  1. Shigeo Fuji
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Contributions

SF, TH, TK, and HN designed the research, organized the project, and wrote the paper. SF performed the statistical analyses. ND, MS, YK, NU, TA, MT, TE, KM, TK, YO, YK, OM, TF, and YA gathered the data. All authors contributed to the final version of the manuscript and have approved it for submission for publication.

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Correspondence to Shigeo Fuji.

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Fuji, S., Hirakawa, T., Takano, K. et al. Disease-specific impact of anti-thymocyte globulin in allogeneic hematopoietic cell transplantation: a nationwide retrospective study on behalf of the JSTCT, transplant complications working group. Bone Marrow Transplant 57, 479–486 (2022). https://doi.org/10.1038/s41409-022-01569-x

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