Comparison of ATG-thymoglobulin with atg-fresenius in patients with hematological malignancies who undergo allogeneic hematopoietic stem cell transplantation: a propensity score-matched analysis

We retrospectively compared the outcomes of 166 patients with hematological malignancies who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) using ATG-Thymoglobulin (ATG-T) at 10 mg/kg or ATG-Fresenius (ATG-F) at 20 mg/kg. Propensity score matching (PSM) analysis was applied, with 44 patients assigned to each group. The ATG-T group showed a trend toward a higher incidence of bacterial infections (72.7% vs. 65.9%, P = 0.064). Additionally, the ATG-T group had a significantly higher incidence of other viral infections, including BK virus and herpes zoster virus (40.9% vs. 15.9%, P = 0.003), compared to the ATG-F group. Furthermore, the ATG-F group experienced a lower incidence of high fever (4.5% vs. 50.0%, P < 0.001) and reduced ATG treatment costs [¥ 45100 (28700-82000) vs. ¥ 56250 (38000-85000), P < 0.001] compared to ATG-T. The incidences of acute GVHD, grade III-IV aGVHD, grades of aGVHD, chronic GVHD, 3-year overall survival (OS), transplantation-related mortality (TRM), non-relapse mortality (NRM), disease-free survival (DFS), and GVHD-free and relapse-free survival (GRFS) were similar between the ATG-T and ATG-F groups. In conclusion, our study suggests that ATG-F is superior to ATG-T in terms of viral infections, fever rate, and treatment cost.