Dr Johannes Schetelig speaks to ecancer about results from a large randomised controlled phase 3 trial comparing anti T lymphocyte globulin and post transplant cyclophosphamide for graft versus host disease prophylaxis in patients undergoing allogeneic haematopoietic cell transplantation from unrelated donors.

The study addresses a key clinical question in transplantation, evaluating whether post transplant cyclophosphamide can achieve non inferiority to the established standard of care using anti T lymphocyte globulin.

In this study of 640 patients with high risk hematologic malignancies, post transplant cyclophosphamide was associated with lower rates of acute and chronic graft versus host disease.

However, this benefit was offset by higher non relapse mortality, primarily driven by infections, leading to a trend toward inferior overall survival compared with anti T lymphocyte globulin. As a result, the trial did not meet its primary endpoint of demonstrating non inferiority.

Dr Schetelig highlights that these findings reinforce anti T lymphocyte globulin in combination with tacrolimus and mycophenolate mofetil as the current standard of care for graft versus host disease prevention in HLA compatible unrelated donor transplantation, while highlighting the need for strategies to improve immune recovery and reduce infection risk with post transplant cyclophosphamide based approaches.