Efficacy and Safety of Combining r-ATG With PTCy for GvHD Prophylaxis in Haploidentical HSC Transplantation for Malignancies-A Systematic Review

Abstract

Allogeneic haematopoietic stem cell transplantation (HSCT) for haematological malignancies can cause acute and chronic graft-versus-host disease (GvHD), impacting graft success and mortality. Rabbit anti-thymocyte globulin (r-ATG) or post-transplant cyclophosphamide (PTCy) is effective in reducing GvHD in haploidentical-HSCT. This review included 17 studies to assess rATG + PTCy for GvHD prophylaxis. Overall acute GvHD grade II-IV, moderate-to-severe chronic GvHD and GvHD-free relapse-free survival rates ranged from 11.50%-35.40%, 2.90%-17.78% and 21.80%-63%, respectively. Although r-ATG + PTCy treatment lowered GvHD incidence and increased survival rates, cytomegalovirus and Epstein-Barr virus reactivation were observed; therefore, more investigations on this treatment are needed, especially on dosing and timing when used for HSCT.

Keywords: anti‐thymocyte globulin (rATG); cyclophosphamide; graft vs. host disease (GvHD); haematopoietic stem cell transplantation; haploidentical.