Antilymphocyte Globulin Improves Outcomes in Patients With Myelofibrosis Undergoing Stem Cell Transplantation
Using antithymocyte/antilymphocyte globulin (ATLG) in patients with myelofibrosis undergoing allogeneic hematopoietic stem cell transplantation (alloHCT) may improve graft-versus-host disease-free and relapse-free survival (GRFS) rates, according to a study published in Bone Marrow Transplantation.
Myelofibrosis, a Philadelphia chromosome-negative myeloproliferative neoplasm, often leads to severe complications such as splenomegaly, anemia, and constitutional symptoms. AlloHCT remains the only potentially curative option, despite its associated risks.
“The aim of this study was to evaluate the impact of ATLG on clinical outcomes of patients with myelofibrosis undergoing an alloHCT in a large international retrospective study,” wrote Kristin Rathje, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and coauthors.
The study included 707 patients from 5 major transplant centers in the US and Europe. Of these, 469 received ATLG-based graft-versus-host disease (GvHD) prophylaxis, while 238 received alternative strategies. Results indicated a significant reduction in acute GvHD among patients treated with ATLG, with a cumulative incidence of 30% compared with 56% in the non-ATLG group by day 180 posttransplant. Severe acute GvHD rates were also lower in the ATLG group, with grade III-IV GvHD occurring in 20% of patients treated with ATLG compared with 25% in the non-ATLG group. Chronic GvHD rates at 6 years were similar between groups, although patients treated with ATLG had a slightly longer median time to develop chronic GvHD.
In terms of survival, the 3-year GRFS rates were higher in the ATLG group (53%) compared with the non-ATLG group (47%), with a 6-year GRFS estimate of 45% versus 37%. Although overall survival and relapse rates did not differ significantly between groups, the improved GRFS suggests that ATLG may benefit patients with myelofibrosis by reducing GvHD-related complications without compromising long-term outcomes.
“In conclusion, this collaborative study on myelofibrosis patients undergoing first alloHCT showed significantly improved GRFS following the use of ATLG, both for matched related and matched unrelated donors,” the study authors concluded.
Reference
Rathje K, Gagelmann N, Salit RB, et al. Anti-T-lymphocyte globulin improves GvHD-free and relapse-free survival in myelofibrosis after matched related or unrelated donor transplantation. Bone Marrow Transplant. 2024;59(8):1154-1160. doi:10.1038/s41409-024-02291-6
