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Post-transplant cyclophosphamide versus antithymocyte globulin in allogeneic hematopoietic cell transplantation: a meta-analysis

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Abstract

Graft-versus-host disease (GVHD) prophylaxis based on post-transplant cyclophosphamide (PTCy) or antithymocyte globulin (ATG) is widely used in allogeneic hematopoietic stem cell transplantations (allo-HCT). The differential impacts of PTCy and ATG on transplantation outcomes are not well characterized. Here we report a meta-analysis of PTCy versus ATG in allo-HCT. Ten studies were eligible, and a total of 1871 patients were included. The incidence of II-IV aGVHD, III-IV aGVHD, and NRM were significantly lower in PTCy arm (HR = 0.63, 95% CI 0.45–0.89; HR = 0.35, 95% CI 0.16–0.77; HR = 0.59, 95% CI 0.48–0.73). PTCy was associated with a better OS and PFS (HR = 0.62, 95% CI = 0.53–0.73; HR = 0.76, 95% CI 0.62–0.93). The relapse rate and cGVHD incidence were not significantly different between PTCy and ATG (HR = 0.85, 95% CI 0.68–1.07; HR = 0.65, 95% CI 0.38–1.12). Thus, compared with ATG, PTCy has a better aGVHD control and OS benefit, without increasing relapse risk, which needs further validation in prospective randomized trials.

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Funding

This study was funded by the National Natural Science Foundation of China (grant number 81572920), Natural Science Foundation of Zhejiang Province of China (grant number Y21H080015, Y15H160038), and Translational Research Grant of National Clinical Research Center for Hematologic Diseases (NCRCH) (2020ZKZC01).

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Authors and Affiliations

  1. Department of Hematology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China

    Feiqiong Gao, Jiawei Zhang, Liming Lin & Yang Xu

  2. Department of Prosthodontics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China

    Jianlai Hu

  3. Zhejiang Provincial Key Laboratory for Cancer Molecular Cell Biology, Life Sciences Institute, Zhejiang University, Hangzhou, 310058, China

    Yang Xu

  4. National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China

    Yang Xu

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  1. Feiqiong Gao
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All authors contributed to the study conception and design. Yang Xu had the idea for the article. Literature search and data analysis were performed by Feiqiong Gao, Jiawei Zhang, Jianlai Hu, and Liming Lin. The first draft of the manuscript was written by Feiqiong Gao. Yang Xu critically revised the work. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Gao, F., Zhang, J., Hu, J. et al. Post-transplant cyclophosphamide versus antithymocyte globulin in allogeneic hematopoietic cell transplantation: a meta-analysis. Ann Hematol 100, 529–540 (2021). https://doi.org/10.1007/s00277-021-04399-x

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