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Improved GVHD-free relapse-free survival when rATG/ATLG is used in allo-HCT from matched sibling donors: an EBMT registry study by the Transplant Complications Working Party

The EBMT recommends rabbit anti-thymocyte or anti-T-lymphocyte globulin (rATG/ATLG) as GVHD prophylaxis in matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). However, discrepancies between recommendations and clinical practice were reflected in the EBMT survey. The...

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Main Authors: Piekarska, Agnieszka (Author) , Abouqateb, Mouad (Author) , Boreland, William (Author) , Peczynski, Christophe (Author) , Zaucha, Jan Maciej (Author) , Kröger, Nicolaus (Author) , Zeiser, Robert (Author) , Ciceri, Fabio (Author) , Schroeder, Thomas (Author) , Luft, Thomas (Author) , Passweg, Jakob (Author) , Kunadt, Desiree (Author) , Stelljes, Matthias (Author) , Blau, Igor Wolfgang (Author) , Platzbecker, Uwe (Author) , Yakoub-Agha, Ibrahim (Author) , Blaise, Didier (Author) , Raiola, Anna Maria (Author) , Tischer, Johanna (Author) , Wagner-Drouet, Eva Maria (Author) , Winkler, Julia (Author) , Schmid, Christoph (Author) , Wulf, Gerald (Author) , Edinger, Matthias (Author) , Maertens, Johan (Author) , Stölzel, Friedrich (Author) , Vydra, Jan (Author) , Zak, Pavel (Author) , Moiseev, Ivan (Author) , Schoemans, Hélène (Author) , Penack, Olaf (Author) , Peric, Zinaida (Author)
Format: Article (Journal)
Language:English
Published: 11 September 2025
In: Bone marrow transplantation
Year: 2025, Volume: 60, Issue: 12, Pages: 1574-1583
ISSN:1476-5365
DOI:10.1038/s41409-025-02692-1
Online Access:Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1038/s41409-025-02692-1
Verlag, lizenzpflichtig, Volltext: https://www.nature.com/articles/s41409-025-02692-1
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Author Notes:Agnieszka Piekarska, Mouad Abouqateb, William Boreland, Christophe Peczynski, Jan Maciej Zaucha, Nicolaus Kröger, Robert Zeiser, Fabio Ciceri, Thomas Schroeder, Thomas Luft, Jakob Passweg, Desiree Kunadt, Matthias Stelljes, Igor Wolfgang Blau, Uwe Platzbecker, Ibrahim Yakoub-Agha, Didier Blaise, Anna Maria Raiola, Johanna Tischer, Eva Maria Wagner-Drouet, Julia Winkler, Christoph Schmid, Gerald Wulf, Matthias Edinger, Johan Maertens, Friedrich Stölzel, Jan Vydra, Pavel Zak, Ivan Moiseev, Hélène Schoemans, Olaf Penack and Zinaida Peric
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Summary:The EBMT recommends rabbit anti-thymocyte or anti-T-lymphocyte globulin (rATG/ATLG) as GVHD prophylaxis in matched sibling donor (MSD) allogeneic hematopoietic cell transplantation (allo-HCT). However, discrepancies between recommendations and clinical practice were reflected in the EBMT survey. Therefore, we performed retrospective EBMT registry analysis from 2014 to 2021 to reinforce the real-world evidence context of rATG/ATLG impact on post-transplantation outcomes. This study included 11,420 adult patients (non-ATG n = 7680 and ATG n = 3740) with hematological malignancies after the first allo-HCT from peripheral blood. Use of ATG was associated with a reduced risk of aGVHD II-IV (Day +100: non-ATG vs ATG, 27.6% vs. 21.6%; adjusted HR 0.7, p < 0.001) and cGVHD (2-year: non-ATG vs ATG, 48.9% vs 30%; adjusted HR 0.45, p < 0.001), improved OS (2-year: 62.9% vs 63.3%; adjusted HR 0.89, p = 0.009), reduced NRM (2-year: 16% vs 12.5%; adjusted HR 0.63, p < 0.001), and higher GRFS (2-year: 32.2% vs 40.7%; adjusted HR 0.72, p < 0.001). While RI was higher in the ATG group (2-year: non-ATG vs ATG, 30.2% vs 34.7%; adjusted HR 1.22, p < 0.001) it did not translate into a significantly lower PFS (2-year: 53.9% vs 52.8%; adjusted HR not significant). Overall, outcomes were favorable for the intermediate rATG/ATLG dose ranges compared to the low and high dose ranges. Administration of rATG/ATLG improved outcomes in MSD allo-HCT recipients, supporting the EBMT recommendation for its use.
Item Description:Gesehen am 06.02.2026
Physical Description:Online Resource
ISSN:1476-5365
DOI:10.1038/s41409-025-02692-1

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