Retrospective study of alemtuzumab vs ATG-based conditioning without irradiation for unrelated and matched sibling donor transplants in acquired severe aplastic anemia: A study from the British Society for Blood and Marrow Transplantation

J. C. Marsh*, R. M. Pearce, M. B.C. Koh, Z. Lim, A. Pagliuca, G. J. Mufti, J. Perry, J. A. Snowden, A. J. Vora, R. T. Wynn, N. Russell, B. Gibson, M. Gilleece, D. Milligan, P. Veys, S. Samarasinghe, M. McMullin, K. Kirkland, G. Cook

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)

Abstract

This retrospective national study compared the use of alemtuzumab-based conditioning regimens for hematopoietic SCT (HSCT) in acquired severe aplastic anemia with antithymocyte globulin (ATG)-based regimens. One hundred patients received alemtuzumab and 55 ATG-based regimens. A matched sibling donor (MSD) was used in 87 (56%), matched unrelated donor (MUD) in 60 (39%) and other related or mismatched unrelated donor (UD) in 8 (5%) patients. Engraftment failure occurred in 9% of the alemtuzumab group and 11% of the ATG group. Five-year OS was 90% for the alemtuzumab and 79% for the ATG groups, P=0.11. For UD HSCT, OS of patients was better when using alemtuzumab (88%) compared with ATG (57%), P=0.026, although smaller numbers of patients received ATG. Similar outcomes for MSD HSCT using alemtuzumab or ATG were seen (91% vs 85%, respectively, P=0.562). A lower risk of chronic GVHD (cGVHD) was observed in the alemtuzumab group (11% vs 26%, P=0.031). On multivariate analysis, use of BM as stem cell source was associated with better OS and EFS, and less acute and cGVHD; young age was associated with better EFS and lower risk of graft failure. This large study confirms successful avoidance of irradiation in the conditioning regimens for MUD HSCT patients.

Original languageEnglish
Pages (from-to)42-48
Number of pages7
JournalBone Marrow Transplantation
Volume49
Issue number1
DOIs
Publication statusPublished - 01 Jan 2014

Keywords

  • Alemtuzumab
  • Aplastic anemia
  • ATG
  • SCT

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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