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Post-transplantation cyclophosphamide and antithymocyte globulin in 8/10 HLA-mismatched unrelated donor transplantation: the analysis on behalf of the transplant complications working party of the EBMT

Bone Marrow Transplantation (2025)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (alloHCT) from 8/10 HLA-matched unrelated donor is performed in a minority of patients. There is little data on its outcomes and consequently, guidelines on optimal transplantation procedures are lacking. The Transplant complications working party of the EBMT performed a registry study comparing approaches to graft-versus-host disease (GVHD) prophylaxis in recipients of alloHCT from 8/10 HLA-mismatched unrelated donors (8/10 MMUD). The analysis included 450 adult patients with hematological malignancies receiving a first alloHCT between 2015 and 2021, GVHD prophylaxis strategies included ATG in 318 and PTCy in 132 patients. AlloHCT from 8/10 MMUD resulted in 21.1% non-relapse mortality, 28.5% cumulative incidence of relapse, 55.7% overall survival (OS), 50.4% progression-free-survival and 39.8% GVHD-relapse-free survival (GRFS). PTCy decreased the risk of grade II-IV (HR 0.63, 95%CI 0.40–0.99) and III–IV acute GVHD (HR 0.31, 95%CI 0.13–0.74), improved OS (HR 0.63, 95%CI 0.41–0.95) and GRFS (HR 0.65, 95%CI 0.47–0.91). No other differences between the groups were documented. Transplantation from female donors to male recipients increased the incidence of extensive chronic GVHD (HR 2.39, 95%CI 1.10–5.19) and decreased PFS (HR 1.49, 95%CI 1.01–2.20). AlloHCT from 8/10 HLA-matched unrelated donor is feasible and the use of PTCy in GVHD prophylaxis improves outcomes.

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Fig. 1: Study description.
Fig. 2: Survival outcomes.
Fig. 3: Acute GVHD.

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Data availability

Primary study data is available through partnering@ebmt.org.

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Author information

Authors and Affiliations

  1. RM Gorbacheva Research Institute, Pavlov University, St Petersburg, Russia

    Ivan Moiseev

  2. Transplant Complications Working Party of EBMT, Paris, France

    Mouad Abouqateb, Christophe Peczynski & William Boreland

  3. S.S.C.V.D Trapianto di Cellule Staminali, Torino, Italy

    Alessandro Busca

  4. University Hospital Eppendorf, Hamburg, Germany

    Nicolaus Kröger

  5. Tor Vergata University of Rome, Rome, Italy

    Raffaella Cerretti

  6. University of Freiburg, Freiburg, Germany

    Robert Zeiser

  7. Essen University Hospital, Essen, Germany

    Thomas Schroeder

  8. Ospedale San Gerardo, Monza, Italy

    Matteo Parma

  9. Saint-Louis Hospital, BMT Unit, Paris, France

    Régis Peffault de Latour

  10. Universitaet Tuebingen, Tuebingen, Germany

    Wolfgang Bethge

  11. Institute of Hematology and Blood Transfusion, Prague, Czech Republic

    Jan Vydra

  12. Programme de Transplantation & Therapie Cellulaire, Marseille, France

    Didier Blaise

  13. Hannover Medical School, Hannover, Germany

    Victoria Panagiota

  14. Ospedale Infantile Regina Margherita, Torino, Italy

    Franca Fagioli

  15. Department of Hematology, University Hospitals Leuven and Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery (ACCENT VV), KU Leuven, Leuven, Belgium

    Hélène Schoemans

  16. Hematology Department, Institut Catala d’Oncologia, Hospital Duran i Reynals, L’Hospitalet De Llobregat, IDIBELL Universitat de Barcelona, Barcelona, Spain

    Alberto Mussetti

  17. Comprehensive Cancer Center, Faculty of Life Sciences and Medicine, King’s College London, London, UK

    Charlotte Graham

  18. Department for Haematology, Oncology and Tumorimmunology, Medical Clinic, Charité Universitätsmedizin Berlin, Berlin, Germany

    Olaf Penack

  19. Department of Hematology, Rijeka University Hospital Centre, Rijeka, Croatia

    Zinaida Peric

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  1. Ivan Moiseev
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Contributions

I.M., C.P., and O.P. designed the study; M.A. performed the statistical analyses; I.M. wrote the manuscript; Z.P., O.P., W.B., C.P., H.S., C.G., and A.M. revised the manuscript; A.B., N.K., R.C., R.Z., T.S., M.P., R.P.L., W.B., J.V., D.B., M.E., and F.F. were the principal investigators at the centers recruiting the largest numbers of patients for the study; and all authors reviewed the final version of the manuscript.

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Correspondence to Ivan Moiseev.

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Competing interests

I.M. reports having received honoraria from Novartis, Sanofi, J&J, Takeda; H.S. reports having received personal fees from Incyte, Janssen, Novartis, Sanofi and from the Belgian Hematological Society (BHS), as well as research grants from Novartis and the BHS, all paid to her institution and not directly related to this work. She has also received non-financial support (travel grants) from Gilead, Pfizer, the EBMT (European Society for Blood and Marrow transplantation) and the CIBMTR (Center for International Bone Marrow Transplantation Research). C.G. reports having received travel support from the EBMT and research funding from the American Association of Cancer Research (AACR).

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All patients in all centers gave their written informed consent to use their personal and medical data for research purposes. Each center is responsible for obtaining such consent before uploading data to the EMBT database. The study was developed and approved by the Transplant Complications Working Party of the EBMT. The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.

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Moiseev, I., Abouqateb, M., Peczynski, C. et al. Post-transplantation cyclophosphamide and antithymocyte globulin in 8/10 HLA-mismatched unrelated donor transplantation: the analysis on behalf of the transplant complications working party of the EBMT. Bone Marrow Transplant (2025). https://doi.org/10.1038/s41409-025-02678-z

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