TY - JOUR AU - Arnon Nagler, AU - Abraham S. Kanate, AU - Myriam Labopin, AU - Fabio Ciceri, AU - Emanuele Angelucci, AU - Yener Koc, AU - Zafer Gülbas, AU - William Arcese, AU - Johanna Tischer, AU - Pietro Pioltelli, AU - Hakan Ozdogu, AU - Boris Afanasyev, AU - Depei Wu, AU - Mutlu Arat, AU - Zinaida Peric, AU - Sebastian Giebel, AU - Bipin Savani, AU - Mohamad Mohty, PY - 2021/06/01 Y2 - 2024/03/28 TI - Post-transplant cyclophosphamide versus anti-thymocyte globulin for graft-versus-host disease prevention in haploidentical transplantation for adult acute lymphoblastic leukemia JF - Haematologica JA - haematol VL - 106 IS - 6 SE - Articles DO - 10.3324/haematol.2020.247296 UR - https://haematologica.org/article/view/9734 SP - 1591-1598 AB - Graft-versus-host disease (GVHD) prophylaxis for unmanipulated haploidentical hematopoietic cell transplantation (haplo-HCT) include post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG). Utilizing EBMT registry, we compared ATG versus PTCy based GVHD prophylaxis in adult acute lymphoblastic leukemia (ALL) patients undergoing haplo-HCT. Included were 434 patients; ATG (n=98) and PTCy (n=336). Median follow-up was ~2 years. Baseline characteristics were similar between the groups except that the ATG-group was more likely to have relapsed/refractory ALL (P=0.008), non-TBI conditioning (P<0.001), peripheral blood graft source (P=<0.001) and transplanted at an earlier time-period (median year of HCT 2011 vs. 2015). The 100-day grade II-IV and III-IV acute-GVHD was similar between ATG and PTCy, as was 2-year chronic-GVHD. On multivariate analysis (MVA), leukemia-free survival (LFS) and overall survival (OS) was better with PTCy compared to ATG prophylaxis. Relapse incidence (RI) was lower in the PTCy group (P=0.03), while non-relapse mortality (NRM) was not different. Advanced disease and lower performance score were associated with poorer LFS and OS and advanced disease with inferior GVHD-free/relapse-free survival (GRFS). Peripheral grafts were associated with higher GVHD compared to bone marrow grafts. In ALL patients undergoing unmanipulated haplo-HCT, PTCy for GVHD prevention resulted in lower RI and improved LFS and OS compared to ATG. ER -