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Abstract
This study aimed to assess the efficacy of dual T-cell suppression using individually tailored doses of antithymocyte globulin (ATG) and attenuated dose of post-transplant cyclophosphamide (PTCy) in haploidentical hematopoietic stem cell transplantation (haplo-HSCT). We conducted a retrospective analysis of 78 adults with acute leukemia or myelodysplastic syndrome who underwent haplo-HSCT using intravenous busulfan and fludarabine conditioning. Thirty-two patients received attenuated ATG/PTCy, while 46 patients received ATG (7.5 mg/kg) as GVHD prophylaxis. The 100-day cumulative incidence of grade III-IV (9.7% vs. 32.4%, P = 0.018) acute GVHD, as well as 2-year moderate-severe chronic GVHD (13.9% vs. 43.9%, P = 0.018) in the ATG/PTCy group were significantly lower than those in the ATG group. The 2-year overall survival was comparable between the two groups. However, 2-year GVHD-free, relapse-free survival in the ATG/PTCy group was significantly higher compared to that in the ATG group (38.9% vs. 21.7%, P = 0.021). Moreover, during post-engraftment period, the ATG/PTCy group exhibited lower incidences of life-threatening bacterial (12.5% vs. 37%, P = 0.033) and viral infection (0% vs. 17.4%, P = 0.035) than the ATG group. In conclusion, the combination of individually tailored ATG and low-dose PTCy appears to be a promising strategy in haplo-HSCT.
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1 Seoul National University Hospital, Department of Internal Medicine, Seoul, Republic of Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X)
2 Seoul National University Hospital, Department of Internal Medicine, Seoul, Republic of Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X); Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X); Seoul National University College of Medicine, Cancer Research Institute, Seoul, Korea (GRID:grid.31501.36) (ISNI:0000 0004 0470 5905); Seoul National University Hospital, Cancer for Medical Innovation, Seoul, Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X)
3 Seoul National University Hospital, Department of Internal Medicine, Seoul, Republic of Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X); Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea (GRID:grid.412484.f) (ISNI:0000 0001 0302 820X)