Addition of anti-thymocyte globulin to standard graft-versus-host disease prophylaxis – Authors' reply

We thank Christoph Bucher and colleagues for their comments and agree that a sensitivity analysis would help to ensure that the use of rituximab did not explain the results from our trial. 1 Walker I Panzarella T Couban S et al. Addition of anti-thymocyte globulin to standard graft-versus-host disease prophylaxis versus standard treatment alone in patients with haematological malignancies undergoing transplantation from unrelated donors: final analysis of a randomised, open-label, multicentre, phase 3 trial. Lancet Haematol. 2020; 7: e100-e111 Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar To address this issue, we reanalysed our data to exclude the 21 individuals who received rituximab to treat reactivations of Epstein-Barr virus, of whom 19 were randomly assigned to receive anti-thymocyte globulin with standard prophylaxis for graft versus host disease (GVHD), and two were randomly assigned to receive standard GVHD prophylaxis alone. One patient in the group who received anti-thymocyte globulin had Epstein-Barr virus reactivation but did not receive rituximab; this patient was retained in the sensitivity analysis. Addition of anti-thymocyte globulin to standard graft-versus-host disease prophylaxis versus standard treatment alone in patients with haematological malignancies undergoing transplantation from unrelated donors: final analysis of a randomised, open-label, multicentre, phase 3 trialThe results of this prespecified 24-month analysis suggest that pretreatment with anti-thymocyte globulin provides clinically meaningful benefits when added to standard GVHD prophylaxis in patients undergoing unrelated donor transplantation, including decreases in use of immunosuppressive therapy, chronic GVHD and its symptoms, and depressive symptoms, and improved overall survival. Anti-thymocyte globulin should be included in the preparative regimens of patients with haematological malignancies selected for unrelated donor transplantation. Full-Text PDF Addition of anti-thymocyte globulin to standard graft-versus-host disease prophylaxisWe have read with great interest the trial published by Irwin Walker and colleagues,1 which compared the addition of anti-thymocyte globulin to standard graft-versus-host disease prophylaxis with standard treatment alone in patients with haematological malignancies undergoing transplantation from unrelated donors. Randomised controlled trials2 in which anti-thymocyte globulin administered before haemopoietic stem cell transplantation was used to reduce the incidence of acute or chronic graft versus host disease (GVHD) have resulted in remarkably heterogeneous results, ranging from detrimental effects on overall survival to reproducible reductions in the cumulative incidence of chronic GVHD, increased quality of life, and reduced steroid use. Full-Text PDF