Background
Methods
Eligibility criteria
Definitions
Statistical analysis
Results
N | ATG | PTCY | Test p value |
---|---|---|---|
1452 | 174 | ||
Follow-up | |||
Median time (IQR) mo | 33.2 (17.6–52.7) | 20.5 (6.9–32.6) | < 0.001 |
Age at allo-HSCT | |||
Median (range) [IQR] | 56 (18.1–77.5) [44.3–62.6] | 46 (18–74.2) [34.7–59.3] | < 0.001 |
Year allo-HSCT | |||
Median (range) [IQR] | 2014 (2010–2017) | 2016 (2010–2017) | < 0.001 |
Time diagnosis to allo-HSCT | |||
Median (range) [IQR] | 5.4 (1.5–17.7) [4.4–6.6] | 4.7 (1.8–17.9) [3.8–7.7] | 0.1 |
AML | |||
De novo | 1206 (83.06%) | 161 (92.53%) | 0.001 |
secAML | 246 (16.94%) | 13 (7.47%) | |
Cytogenetics (MRC) | |||
Good | 59 (4.06%) | 4 (2.3%) | 0.19 |
Interm | 740 (50.96%) | 80 (45.98%) | |
Poor | 291 (20.04%) | 35 (20.11%) | |
NA/failed | 362 (24.93%) | 55 (31.61%) | |
Conditioning regimen | |||
MAC | 687 (47.31%) | 76 (43.68%) | 0.36 |
RIC | 765 (52.69%) | 98 (56.32%) | |
Gaft cell type | |||
BM | 143 (9.85%) | 18 (10.34%) | 0.84 |
PBSC | 1309 (90.15%) | 156 (89.66%) | |
Kanofsky performance score | |||
< 90 | 331 (24.68%) | 29 (16.76%) | 0.02 |
≥ 90 | 1010 (75.32%) | 144 (83.24%) | |
Missing | 111 | 1 | |
Patient sex | |||
Male | 759 (52.27%) | 98 (56.32%) | 0.31 |
Female | 693 (47.73%) | 76 (43.68%) | |
Female donor-male recipient | 165 (11.41%) | 26 (14.94%) | 0.17 |
Patient CMV serostatus | |||
Negative | 499 (34.92%) | 43 (25.15%) | 0.011 |
Positive | 930 (65.08%) | 128 (74.85%) | |
Missing | 23 | 3 | |
Engraftement | |||
Graft failure | 12 (0.83%) | 2 (1.16%) | 0.65 |
Engrafted | 1432 (99.17%) | 170 (98.84%) | |
Missing | 8 | 2 |
Comparative analysis of transplant outcomes with ATG or PTCY
180-day acute GVHD II–IV | 180-day acute GVHD III–IV | 2-year chronic GVHD | 2-year ext. chronic GVHD | |
---|---|---|---|---|
PTCY | 28.8% [22.2–35.7] | 8.8% [5.1–13.7] | 31.4% [23.3–39.8] | 18.5% [12–26.1] |
ATG | 29.2% [26.8–31.6] | 9% [7.6–10.6] | 33.6% [31–36.2] | 13.1% [11.2–15] |
pvalue | 0.68 | 0.89 | 0.43 | 0.11 |
Acute GVHD II–IV | Acute GVHD III–IV | Chronic GVHD | Ext. chronic GVHD | |||||
---|---|---|---|---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | |
ATG vs PTCY | 0.98 (0.66–1.46) | 0.93 | 0.84 (0.42–1.71) | 0.64 | 1.22 (0.79–1.87) | 0.37 | 0.64 (0.37–1.09) | 0.09 |
Age (per 10 years) | 1 (0.91–1.09) | 0.92 | 1.01 (0.86–1.18) | 0.92 | 1.06 (0.97–1.16) | 0.20 | 1.03 (0.89–1.18) | 0.73 |
sec. AML vs de novo | 1.23 (0.95–1.61) | 0.12 | 1.26 (0.79–2) | 0.34 | 1.01 (0.76–1.33) | 0.96 | 1.62 (1.1–2.39) | 0.01 |
Adverse cytogenetics vs other | 0.94 (0.74–1.21) | 0.65 | 1.12 (0.73–1.71) | 0.60 | 0.73 (0.56–0.96) | 0.03 | 0.61 (0.39–0.95) | 0.03 |
Female donor-male recipient vs other | 1.27 (0.96–1.68) | 0.10 | 1.67 (1.05–2.66) | 0.03 | 1.07 (0.79–1.45) | 0.65 | 1.05 (0.66–1.67) | 0.83 |
RIC vs MAC | 0.79 (0.62–1) | 0.046 | 0.89 (0.59–1.36) | 0.60 | 0.97 (0.76–1.23) | 0.79 | 0.78 (0.54–1.14) | 0.20 |
KPS ≥ 90 | 0.83 (0.65–1.06) | 0.13 | 0.64 (0.42–0.97) | 0.03 | 0.91 (0.71–1.17) | 0.45 | 0.92 (0.63–1.34) | 0.67 |
Patient CMV positivity | 1.05 (0.85–1.31) | 0.64 | 1.01 (0.68–1.48) | 0.98 | 1.28 (1.03–1.6) | 0.03 | 1.05 (0.75–1.47) | 0.77 |
Donor CMV positivity | 1 (0.81–1.23) | 0.99 | 1.06 (0.73–1.53) | 0.77 | 0.97 (0.79–1.2) | 0.80 | 1.32 (0.96–1.82) | 0.09 |
Year of transplantation | 1.01 (0.96–1.06) | 0.75 | 1.03 (0.94–1.12) | 0.57 | 1 (0.95–1.05) | 0.94 | 1.07 (0.99–1.16) | 0.09 |
PBSC vs BM | 1.05 (0.75–1.47) | 0.77 | 1.1 (0.6–2) | 0.76 | 1.1 (0.78–1.55) | 0.59 | 1.37 (0.79–2.4) | 0.26 |
Relapse | NRM | LFS | OS | GRFS | |
---|---|---|---|---|---|
PTCY | 25.2% [18–32.9] | 15.2% [9.7–21.8] | 59.7% [50.6–67.6] | 62.7% [53.4–70.7] | 41.6% [33–50] |
ATG | 23.7% [21.4–26] | 16.7% [14.8–18.8] | 59.6% [56.8–62.2] | 64.8% [62.1–67.4] | 49.3% [46.6–52.1] |
pvalue | 0.6 | 0.6 | 0.97 | 0.95 | 0.2 |
Engraftment and GVHD
OS, LFS, and GRFS
Relapse | NRM | LFS | OS | GRFS | ||||||
---|---|---|---|---|---|---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | |
ATG vs PTCy | 0.93 (0.63–1.37) | 0.71 | 1.04 (0.65–1.66) | 0.86 | 0.98 (0.74–1.29) | 0.86 | 0.94 (0.7–1.27) | 0.71 | 0.89 (0.7–1.13) | 0.35 |
Age (per 10 years) | 1.01 (0.92–1.11) | 0.9 | 1.37 (1.2–1.56) | < 10–5 | 1.13 (1.05–1.22) | 0.001 | 1.21 (1.12–1.32) | < 10–5 | 1.06 (1–1.14) | 0.07 |
sec. AML vs de novo | 1.14 (0.86–1.53) | 0.36 | 1.39 (1.02–1.9) | 0.04 | 1.24 (1.01–1.53) | 0.04 | 1.29 (1.03–1.6) | 0.02 | 1.25 (1.03–1.52) | 0.02 |
Adverse cytogenetics vs other | 1.77 (1.41–2.24) | < 10–5 | 1.19 (0.88–1.61) | 0.27 | 1.51 (1.26–1.81) | < 10–5 | 1.42 (1.17–1.72) | 0.0004 | 1.36 (1.15–1.61) | 0.0003 |
Female donor-male recipient vs other | 0.54 (0.36–0.8) | 0.002 | 1.46 (1.04–2.05) | 0.03 | 0.89 (0.69–1.15) | 0.38 | 0.93 (0.71–1.22) | 0.6 | 1.11 (0.89–1.38) | 0.35 |
RIC vs MAC | 1.06 (0.82–1.36) | 0.66 | 0.84 (0.63–1.13) | 0.25 | 0.97 (0.81–1.17) | 0.75 | 0.91 (0.74–1.11) | 0.33 | 0.98 (0.83–1.15) | 0.77 |
KPS ≥ 90 | 1.16 (0.9–1.51) | 0.26 | 0.85 (0.64–1.13) | 0.27 | 1.02 (0.84–1.23) | 0.86 | 0.98 (0.81–1.2) | 0.87 | 0.96 (0.81–1.13) | 0.60 |
Patient CMV positivity | 0.99 (0.79–1.24) | 0.92 | 1.31 (0.99–1.73) | 0.06 | 1.11 (0.93–1.32) | 0.24 | 1.12 (0.93–1.35) | 0.22 | 1.11 (0.95–1.29) | 0.21 |
Donor CMV positivity | 1.17 (0.94–1.45) | 0.16 | 1 (0.77–1.3) | 0.98 | 1.09 (0.92–1.28) | 0.33 | 1.09 (0.91–1.3) | 0.34 | 1.11 (0.96–1.29) | 0.16 |
Year of transplantation | 1.04 (0.99–1.1) | 0.12 | 1 (0.94–1.07) | 0.99 | 1.02 (0.98–1.07) | 0.26 | 1.02 (0.98–1.07) | 0.37 | 1.03 (1–1.07) | 0.07 |
PBSC vs BM | 0.96 (0.68–1.36) | 0.82 | 1.29 (0.8–2.09) | 0.29 | 1.05 (0.8–1.39) | 0.73 | 1.11 (0.82–1.49) | 0.50 | 1.14 (0.88–1.47) | 0.31 |