Comparison of GvHD prophylaxis regimens based on in vivo T-cell depletion (ATG vs. alemtuzumab) in patients with AML undergoing allo-HCT from unrelated donors with intermediate transplant conditioning intensity protocols: a registry study on behalf o

Abstract Allogeneic hematopoietic cell transplantation is a potentially curative therapy for acute myeloid leukemia (AML), but its success is limited by graft-versus-host disease (GvHD). Optimal in vivo T-cell depletion strategies for GvHD prophylaxis given with conditioning regimens remain under investigation. We compared antithymocyte globulin (ATG) and alemtuzumab as GvHD prophylaxis in adult AML patients in complete remission (CR1/CR2) undergoing allogeneic cell transplantation from unrelated-donors conditioned with intermediate-intensity regimens. From the EBMT registry, 1545 patients were identified (710 ATG; 835 alemtuzumab). Patients receiving ATG were slightly older and had higher comorbidity scores, but groups were otherwise comparable. At 3 years, ATG was associated with superior overall survival (58.3% vs. 50.4%, p = 0.03) and leukemia-free survival (52.1% vs. 45.7%, p = 0.014). ATG recipients also demonstrated significantly lower relapse incidence (21.9% vs. 28.1%, p = 0.006), while non-relapse mortality remained similar between groups (26% vs. 26.3%, p = 0.46). Although ATG was associated with a higher incidence of acute GvHD, chronic GvHD rates did not differ significantly. In summary, for AML patients in complete remission receiving intermediate-intensity conditioning, ATG improved long-term survival and reduced relapse risk compared with alemtuzumab, despite increased acute GvHD. These findings support ATG as an effective GvHD prophylactic option in this setting.

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Publication Details

Journal
Bone Marrow Transplantation
Published
2026-09-10
DOI
https://doi.org/10.1038/s41409-026-03016-7
Primary Topic
Acute Myeloid Leukemia Research
Type
article
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article

Comparison of GvHD prophylaxis regimens based on in vivo T-cell depletion (ATG vs. alemtuzumab) in patients with AML undergoing allo-HCT from unrelated donors with intermediate transplant conditioning intensity protocols: a registry study on behalf o

Jesús Duque‐Afonso, Éolia Brissot, Caroline Pabst, Alexandros Spyridonidis et al.
Bone Marrow Transplantation
Acute Myeloid Leukemia Research
article

Comparison of GvHD prophylaxis regimens based on in vivo T-cell depletion (ATG vs. alemtuzumab) in patients with AML undergoing allo-HCT from unrelated donors with intermediate transplant conditioning intensity protocols: a registry study on behalf o

Jesús Duque‐Afonso, Éolia Brissot, Caroline Pabst, Alexandros Spyridonidis, Mohamad Mohty, Fabio Ciceri, Eva Wagner-Drouet, Jürgen Finke, Jan Vydra, Friedrich Stölzel, Arnon Nagler, Katherine Clesham, Jacques‐Emmanuel Galimard, Eleni Tholouli, Emma Nicholson, Robert Zeiser, Deborah Richardson, Elisa Sala, Matthias Eder, Charles Crawley, Caroline Besley, Francesca Kinsella, Alain Gadisseur, Adrian Bloor, Jennifer Byrne, Thibeault Ferhat-Berland, Patrick Medd
article en

Abstract

Abstract Allogeneic hematopoietic cell transplantation is a potentially curative therapy for acute myeloid leukemia (AML), but its success is limited by graft-versus-host disease (GvHD). Optimal in vivo T-cell depletion strategies for GvHD prophylaxis given with conditioning regimens remain under investigation. We compared antithymocyte globulin (ATG) and alemtuzumab as GvHD prophylaxis in adult AML patients in complete remission (CR1/CR2) undergoing allogeneic cell transplantation from unrelated-donors conditioned with intermediate-intensity regimens. From the EBMT registry, 1545 patients were identified (710 ATG; 835 alemtuzumab). Patients receiving ATG were slightly older and had higher comorbidity scores, but groups were otherwise comparable. At 3 years, ATG was associated with superior overall survival (58.3% vs. 50.4%, p = 0.03) and leukemia-free survival (52.1% vs. 45.7%, p = 0.014). ATG recipients also demonstrated significantly lower relapse incidence (21.9% vs. 28.1%, p = 0.006), while non-relapse mortality remained similar between groups (26% vs. 26.3%, p = 0.46). Although ATG was associated with a higher incidence of acute GvHD, chronic GvHD rates did not differ significantly. In summary, for AML patients in complete remission receiving intermediate-intensity conditioning, ATG improved long-term survival and reduced relapse risk compared with alemtuzumab, despite increased acute GvHD. These findings support ATG as an effective GvHD prophylactic option in this setting.

Bone Marrow Transplantation
University College Hospital (GB), Vita-Salute San Raffaele University (IT), Inserm (FR), University of Freiburg (DE), Johannes Gutenberg University Mainz (DE), Heidelberg University (DE), Queen Elizabeth Hospital Birmingham (GB), Sheba Medical Center (IL), University Hospitals Bristol NHS Foundation Trust (GB), University Medical Center Freiburg (DE), Southampton General Hospital (GB), General University Hospital of Patras (GR), Manchester Royal Infirmary (GB), University Hospital Heidelberg (DE), Derriford Hospital (GB), Nottingham City Hospital (GB), Medizinische Hochschule Hannover (DE), Sorbonne Université (FR), University Medical Center of the Johannes Gutenberg University Mainz (DE), Institute of Haematology and Blood Transfusion (CZ), Assistance Publique – Hôpitaux de Paris (FR), Antwerp University Hospital (BE), Hôpital Saint-Antoine (FR), University Hospital Schleswig-Holstein (DE), Royal Marsden Hospital (GB), The Christie NHS Foundation Trust (GB), Centre de Recherche Saint-Antoine (FR), Istituti di Ricovero e Cura a Carattere Scientifico (IT), University Hospital Ulm (DE), Addenbrooke's Hospital (GB), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University Hospitals Bristol and Weston NHS Foundation Trust (GB), University College London (GB), University of Lübeck (DE)
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