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Impact of in vivo T-cell depletion in patients with myelodysplastic syndromes undergoing allogeneic hematopoietic stem cell transplant: a registry study from the Chronic Malignancies Working Party of the EBMT

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Abstract

While in vivo T-cell depletion (TCD) is widely used, its benefit in patients with MDS still remains a matter of debate. This study evaluates the impact of TCD on outcomes, and compares ATG and alemtuzumab, in patients with MDS. 1284 patients from the EBMT registry were included in this study with 470 patients in the no-TCD group and 814 in the TCD group (alemtuzumab N = 168; ATG N = 646). At 6 months, aGVHD III-IV cumulative incidences (CI) for no-TCD, ATG or alemtuzumab groups were 13% vs 14% vs 11% (ns), respectively. At 5 years, CI of chronic GVHD were 64% vs 52% vs 51% (p < 0.00017); and CI of relapse was 23% vs 25% vs 39% (p < 0.0001) for no TCD, ATG and alemtuzumab respectively; OS was 47% vs 46% vs 34% (p = 0.009) respectively; and GRFS was 21% vs 28% and 20% (p = 0.045) respectively. In multivariable analysis, ATG improved GRFS, and alemtuzumab decreased OS. Both ATG and alemtuzumab decreased risk of chronic GVHD, but the increased risk of relapse with alemtuzumab is associated with a poor GRFS and suggest to not use alemtuzumab in the setting of allo-SCT for high risk disease.

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Fig. 1: Cumulative incidence.
Fig. 2: Overall survival.

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Authors and Affiliations

  1. CHU Bordeaux, F-33000, Bordeaux, France

    Edouard Forcade

  2. Hopital Saint-Louis, APHP, Université de Paris, Paris, France

    Sylvie Chevret & Marie Robin

  3. Department of Medicine I, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Jürgen Finke

  4. Universitaetsklinikum Dresden, Dresden, Germany

    Gerhard Ehninger

  5. University Hospital Eppendorf, Hamburg, Germany

    Francis Ayuk & Nicolaus Kröger

  6. University Hospital, Essen, Germany

    Dietrich Beelen

  7. EBMT Data Office, Leiden, The Netherlands

    Linda Koster

  8. Hannover Medical School, Hannover, Germany

    Arnold Ganser

  9. HUCH Comprehensive Cancer Center, Helsinki, Finland

    Liisa Volin

  10. Rigshospitalet, Copenhagen, Denmark

    Henrik Sengeloev

  11. Centre Hospitalier Lyon Sud, Lyon, France

    Mauricette Michallet

  12. University Hospital, LMU Munich, Department of Medicine III, Munich, Germany

    Johanna Tischer

  13. Charles University Hospital, Pilsen, Czech Republic

    Pavel **dra

  14. Hospital Regional de Málaga, Málaga, Spain

    Maria Jesús Pascual Cascon

  15. Medical Park Hospitals, Antalya, Turkey

    Yener Koc

  16. Sisli Florence Nightingale Hospital, Istanbul, Turkey

    Mutlu Arat

  17. Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland

    Agnieszka Tomaszewska

  18. St James Hospital, Dublin, Ireland

    Patrick Hayden

  19. Radboud University - Nijmegen Medical Centre, Nijmegen, The Netherlands

    Theo de Witte

  20. CHU de Lille, université de Lille, LIRIC, Inserm U995, 59000, Lille, France

    Ibrahim Yakoub-Agha

Authors
  1. Edouard Forcade
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Contributions

Contribution: EF and MR designed the study; SC performed statistical analysis; LK provided data management; JF, GE, FA, DB, AG, GS, LV, HS, MM, JT, PJ, MJPC, YK, MA, AT, PA, TdW, IYA, NK and MR provided patients, reviewed and edited the manuscript. All co-authors reviewed and approved the last version of the manuscript.

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Correspondence to Marie Robin.

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Competing interests

NK: research grant from Neovii; MA: Board speaker for Neovii. EF: travel grant from Neovii.

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Appendix

List of centers contributing to the DQI-EBMT MDS registry:

Rigshospitalet, Copenhagen, Denmark; Hopital St Louis, Paris, France; University Hospital, Essen, Germany; Hannover Medical School, Hannover, Germany; Klinikum Grosshadern, Munich, Germany, HUCH Comprehensive Cancer Center, Helsinky, Finland; Hospital Regional de Malaga, Malaga, Spain; University Hospital Eppendorf, Hamburg, Germany; Centre Hospitalier de Lyon, Lyon, France; Charles University Hospital, Pilsen, Czech Republic; Universitaetsklinikum Dresden, Dresden, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany; Medical Park Hospitals, Antalya, Turkey; Central Clinical Hospital, Warsaw, Poland; Florence Nightingale Sisli Hospital, Istanbul, Turkey.

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Forcade, E., Chevret, S., Finke, J. et al. Impact of in vivo T-cell depletion in patients with myelodysplastic syndromes undergoing allogeneic hematopoietic stem cell transplant: a registry study from the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 57, 768–774 (2022). https://doi.org/10.1038/s41409-022-01620-x

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