Despite notable advancements in immunotherapy in the past decades, allogeneic hematopoietic stem cell transplantation (allo-HCT) remains a promising, potentially curative treatment modality. Only a limited number of studies have performed a direct comparison of two prevalent rabbit anti-thymocyte globulin (r-ATG) formulations—specifically, Thymoglobuline (ATG-T, formerly Genzyme) and Grafalon (ATG-G, formerly Fresenius). The primary objective of our retrospective analysis was to compare the outcomes of adult patients undergoing matched or mismatched unrelated donor (MUD/MMUD) allo-HCT, with a graft-versus-host disease (GvHD) prophylaxis based on either ATG-T or ATG-G. A total of 87 patients who had undergone allo-HCT between 2012 and 2022 were included. We observed no significant differences between ATG-T and ATG-G concerning the occurrence of acute graft-versus-host disease (aGvHD), regardless of its severity. Conversely, chronic graft-versus-host disease (cGvHD) occurred less frequently in the ATG-T group compared to the ATG-G group (7.5% vs. 38.3%,p= 0.001). The negative impact of ATG-G on cGvHD was confirmed by multivariate analysis (HR 8.12, 95% CI 2.06–32.0,p= 0.003). Patients treated with ATG-T manifested a higher incidence of cytomegalovirus (CMV) reactivations (70% vs. 31.9%,p< 0.001), with a shorter time between transplant and CMV (<61 days, 77.8% vs. 33.3%,p= 0.008) and a higher median CMV copy number (1000 vs. 0,p= 0.004). Notably, despite a higher occurrence of CMV reactivations in the ATG-T cohort, most patients were asymptomatic compared to ATG-G (85.7% vs. 43.8%,p= 0.005). By multivariate analysis, only aGvHD had an influence on CMV reactivations (HR 0.18, 95% CI 0.04–0.75,p= 0.019). Finally, we observed no significant differences in terms of 5-year overall survival (OS) and 3-year relapse-free survival (RFS) while comparing ATG-T and ATG-G (32.0% vs. 40.3%,p= 0.423; 66.7% vs. 60.4%,p= 0.544, respectively).
尽管过去几十年免疫疗法取得了显著进展，异基因造血干细胞移植（allo-HCT）仍是一种具有前景且可能实现根治的治疗手段。目前仅有少数研究对两种常用的兔抗胸腺细胞球蛋白（r-ATG）制剂——即胸腺球蛋白（ATG-T，原属健赞公司）和格拉法隆（ATG-G，原属费森尤斯公司）——进行过直接比较。本研究通过回顾性分析，旨在比较接受匹配或不匹配无关供者（MUD/MMUD）allo-HCT的成年患者，在使用ATG-T或ATG-G作为移植物抗宿主病（GvHD）预防方案后的临床结局。研究共纳入2012年至2022年间接受allo-HCT的87例患者。我们发现，无论急性移植物抗宿主病（aGvHD）的严重程度如何，ATG-T与ATG-G在aGvHD发生率方面均无显著差异。相反，与ATG-G组相比，ATG-T组的慢性移植物抗宿主病（cGvHD）发生率较低（7.5% vs. 38.3%，p=0.001）。多变量分析证实了ATG-G对cGvHD的负面影响（风险比8.12，95%置信区间2.06–32.0，p=0.003）。接受ATG-T治疗的患者巨细胞病毒（CMV）再激活发生率更高（70% vs. 31.9%，p<0.001），从移植到CMV再激活的时间更短（<61天者占77.8% vs. 33.3%，p=0.008），且CMV拷贝数中位数更高（1000 vs. 0，p=0.004）。值得注意的是，尽管ATG-T组CMV再激活发生率更高，但与ATG-G组相比，大多数患者无症状（85.7% vs. 43.8%，p=0.005）。多变量分析显示，仅aGvHD对CMV再激活有影响（风险比0.18，95%置信区间0.04–0.75，p=0.019）。最后，在比较ATG-T与ATG-G时，我们观察到5年总生存率（OS）和3年无复发生存率（RFS）均无显著差异（分别为32.0% vs. 40.3%，p=0.423；66.7% vs. 60.4%，p=0.544）。
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