Anti-thymocyte globulin (ATG)- or alemtuzumab-based graft-versus-host disease prophylaxis in reduced-intensity conditioning allogeneic hematopoietic cell transplantation (HCT) for patients 40 years and older with acute lymphoblastic leukemia in first complete remission: a study from the EBMT Acute Leukemia Working Party
Bug, Gesine Labopin, Myriam Byrne, Jennifer L Mielke, Stephan Orchard, Kim Paneesha, Shankara Potter, Victoria Blaise, Didier Besley, Caroline Snowden, John A
Bug, Gesine
Labopin, Myriam
Byrne, Jennifer L
Mielke, Stephan
Orchard, Kim
Paneesha, Shankara
Potter, Victoria
Blaise, Didier
Besley, Caroline
Snowden, John A
Abstract
For patients with high-risk acute lymphoblastic leukemia (ALL), allogeneic hematopoietic cell transplantation (HCT) remains standard of care. In the setting of an HLA-matched unrelated donor HCT, in vivo T-cell depletion (TCD) for prophylaxis of graft versus host disease (GVHD) relies on anti-thymocyte globulin (ATG) in Europe and alemtuzumab in the UK. In a retrospective study from the EBMT registry, we pair-matched 90 ALL patients aged ≥40 years transplanted in CR1 according to age (median 56 years) and ALL subtype (37.8% Ph-negative B-ALL, 46.7% Ph-positive B-ALL, 15.6% T-ALL). Reduced-intensity conditioning included fludarabine/melphalan (94.4%) in the alemtuzumab and fludarabine/busulfan (36.7%), fludarabine/total body irradiation (21.1%), fludarabine/melphalan (14.4%) and thiotepa/busulfan/fludarabine (13.3%) in the ATG group. Two-year leukemia-free and overall survival were similar between groups (Alemtuzumab: 56.4% vs ATG: 50.7%, HR 0.82, p = 0.34, and 62.7% vs 62.9%, HR 0.91, p = 0.67), as were cumulative incidence of relapse (23.7% vs 23.9%, HR 0.89, p = 0.69) and non-relapse mortality (19.9% vs 25.4%, HR 0.75, p = 0.32), resulting in similar GVHD- and relapse-free survival (GRFS) of 48.9% vs 42.1%, HR 0.8, p = 0.24. With GVHD and infections as main reasons for death in both groups, we conclude that both IS strategies are both safe for RIC HCT of these ALL patients.
MIDER Authors
Affiliations
Goethe University; Sorbonne University; Assistance Publique – Hopitaux de Paris; Nottingham University Hospitals Trust; Karolinska CCC and ATMP Center; University Hospital Southampton NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; King’s College Hospital NHS Foundation Trust; Aix Marseille University; University Hospitals Bristol and Weston NHS Foundation Trust; Sheffield Teaching Hospitals NHS Trust; University of Sheffield; Centre Hospitalier Universitaire de Lille; Universite de Lille; NHS Greater Glasgow and Clyde; Cambridge University Hospitals NHS Foundation Trust; University of Patras; University Hospital La Fe; Maria Sklodowska-Curie National Research Institute of Oncology; IRCCS San Raffaele Scientific Institute
Date
2026-03-06
Type
Article
Collections
Citation
Bug G, Labopin M, Byrne JL, Mielke S, Orchard K, Paneesha S, Potter V, Blaise D, Besley C, Snowden JA, Yakoub-Agha I, Clark A, Crawley C, Spyridonidis A, Sanz J, Brissot E, Giebel S, Ciceri F, Mohty M. Anti-thymocyte globulin (ATG)- or alemtuzumab-based graft-versus-host disease prophylaxis in reduced-intensity conditioning allogeneic hematopoietic cell transplantation (HCT) for patients 40 years and older with acute lymphoblastic leukemia in first complete remission: a study from the EBMT Acute Leukemia Working Party. Bone Marrow Transplant. 2026 Apr;61(4):462-468. doi: 10.1038/s41409-026-02805-4. Epub 2026 Mar 6.