• Francesca Bonifazi, Jacopo Olivieri, Mariarosaria Sessa, Elisa Dan, Barbara Sinigaglia, Simonetta Rizzi, Maria Rosa Motta, Andrea Bontadini, Francesca Ulbar, Valeria Giudice, Cristina Papayannidis, Antonio Curti, Angela Chiereghin, Tiziana Lazzarotto, Michele Cavo, and Mario Arpinati.
• Department of Hematology "L. and A. Seràgnoli," University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: francesca.bonifazi@unibo.it.
• Biol. Blood Marrow Transplant. 2018 Dec 1; 24 (12): 2450-2458.

AbstractChronic graft-versus-host disease (cGVHD) is a major complication after stem cell transplantation (HSCT). Several randomized studies already demonstrated that anti-T lymphoglobulin (ATLG) is effective in preventing GVHD after myeloablative unrelated and HLA-identical sibling transplants. However, the issue of doses and the potential increase of relapses still remain unsolved. Here we report data on 190 patients with acute leukemia and myelodysplastic syndrome who underwent an unrelated HSCT with low-dose ATLG (15 to 30 mg/kg) given at an earlier timing (days -6 to -2). HSCT was performed from HLA 10/10 (n = 62, 33%), 9/10 (n = 91, 48%), 8/10 (n = 30, 16%), and <8/10 (n = 7, 4%) identical unrelated donor. Peripheral blood was the stem cell source in 42% (n = 80). Median follow-up was 51 months. Grades II to IV and III to IV acute GVHD were 26% and 9%, respectively, and 2-year overall and moderate to severe cGVHD were 23% and 14%, respectively. The 3-year incidences of relapse and nonrelapse mortality were 26% and 18%, respectively. The rates of 3-year overall survival (OS), disease-free survival (DFS), and GVHD-free and relapse-free survival (GRFS) were 60%, 56% and 44%, respectively. Factors such as younger donor, good performance status, and early disease were associated with better outcome in terms of OS, DFS, and GRFS. Our data indicate that doses of ATLG lower that those used in randomized clinical trials can be used for GVHD prevention, even in the adult setting, without clear increases in relapse and infections; these findings need to be further validated by a prospective randomized study.Copyright © 2018. Published by Elsevier Inc.

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