Impact of anti-thymocyte globulin dose for graft-versus-host disease prophylaxis in allogeneic hematopoietic cell transplantation from matched unrelated donors: a multicenter experience.
Adult
Allografts
Antilymphocyte Serum
/ administration & dosage
Cyclosporine
/ therapeutic use
Disease-Free Survival
Dose-Response Relationship, Immunologic
Female
Graft vs Host Disease
/ epidemiology
Hematologic Neoplasms
/ therapy
Hematopoietic Stem Cell Transplantation
/ adverse effects
Histocompatibility
Humans
Immunosuppressive Agents
/ adverse effects
Incidence
Infections
/ etiology
Kaplan-Meier Estimate
Male
Methotrexate
/ therapeutic use
Middle Aged
Mycophenolic Acid
/ therapeutic use
Proportional Hazards Models
Recurrence
Retrospective Studies
T-Lymphocytes
/ immunology
Unrelated Donors
Anti-thymocyte globulin
GvHD
Hematopoietic stem cell transplantation
Matched unrelated donors
Journal
Annals of hematology
ISSN: 1432-0584
Titre abrégé: Ann Hematol
Pays: Germany
ID NLM: 9107334
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
05
11
2020
accepted:
08
04
2021
pubmed:
6
5
2021
medline:
22
6
2021
entrez:
5
5
2021
Statut:
ppublish
Résumé
Despite the widespread use of rabbit anti-thymocyte globulin (ATG) to prevent acute and chronic graft-versus-host disease (aGVHD, cGVHD) after allogeneic hematopoietic cell transplantation (allo-HCT), convincing evidence about an optimal dose is lacking. We retrospectively evaluated the clinical impact of two different ATG doses (5 vs 6-7.5 mg/kg) in 395 adult patients undergoing HSCT from matched unrelated donors (MUD) at 3 Italian centers. Cumulative incidence of aGVHD and moderate-severe cGVHD did not differ in the 2 groups. We observed a trend toward prolonged overall survival (OS) and disease-free survival (DFS) with lower ATG dose (5-year OS and DFS 56.6% vs. 46.3%, p=0.052, and 46.8% vs. 38.6%, p=0.051, respectively) and no differences in relapse incidence and non-relapse mortality. However, a significantly increased infection-related mortality (IRM) was observed in patients who received a higher ATG dose (16.7% vs. 8.8% in the lower ATG group, p=0.019). Besides, graft and relapse-free survival (GRFS) was superior in the lower ATG group (5-year GRFS 43.1% vs. 32.4%, p=0.014). The negative impact of higher ATG dose on IRM and GRFS was confirmed by multivariate analysis. Our results suggest that ATG doses higher than 5 mg/kg are not required for MUD allo-HCT and seem associated with worse outcomes.
Identifiants
pubmed: 33948721
doi: 10.1007/s00277-021-04521-z
pii: 10.1007/s00277-021-04521-z
pmc: PMC8195753
doi:
Substances chimiques
Antilymphocyte Serum
0
Immunosuppressive Agents
0
Cyclosporine
83HN0GTJ6D
Mycophenolic Acid
HU9DX48N0T
Methotrexate
YL5FZ2Y5U1
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1837-1847Références
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