Comparison of Two Doses of Antithymocyte Globulin in Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

The appropriate dose of antithymocyte globulin (ATG) to be used in reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) is yet to be determined. We retrospectively analyzed the outcomes of patients who underwent unrelated or mismatch related RIC allo-HSCT for hematologic malignancies and received r-ATG (4.5 mg/kg, 141 patients) versus R-ATG (6 mg/kg, 216 patients). There was a higher incidence of cytomegalovirus (P < .001) and Epstein-Barr virus viremia (P =.03) in the R-ATG group than in the r-ATG group. The cumulative incidences of acute graft-versus-host disease (aGVHD) grades II to IV at day 180 in the r-ATG and R-ATG groups were 59% and 44% (P = .006) and grades III to IV 20% and 12% (P = .029), respectively. In multivariable models adjusting for disease diagnosis, the risk of aGVHD grades III to IV did not reach statistical significance (P = .087). The respective cumulative incidences of chronic GVHD in the r-ATG and R-ATG groups were 26% and 15% (P = .10), respectively. There were no significant differences in relapse rate (P = .24), nonrelapse mortality (P = .96), progression-free survival (P = .24), overall survival (P = .70), and GVHD-free relapse-free survival (P = .24). In this retrospective analysis, aGVHD incidence was higher in those treated with r-ATG compared with R-ATG, but this did not translate into significant differences of clinical outcome. Given the increasing use of RIC allo-HSCT for treating malignant hematologic conditions, the correct dose and schedule of ATG administration should be defined by prospective randomized controlled trials.

Impact of Immunosuppressive Strategies on Post–Kidney Transplantation Thrombocytopenia

“…Whereas there was not any dose-dependent effect of GRA reported in the literature, several studies have reported that increased dose of THY is correlated with more frequent infections (29,30) and less effective T-cell recovery (6). In our study, platelet counts did not depend on the dose of THY.…”

Factors Associated with Post-Transplant Active Epstein-Barr Virus Infection and Lymphoproliferative Disease in Hematopoietic Stem Cell Transplant Recipients: A Systematic Review and Meta-Analysis

“…The method used to diagnose PTLD was not detailed in one study. The length of follow-up was an important source of variation between studies; in some cases the follow-up period was not reported [31,32,34,40,46,48,52,55,59,61,63,73,81,83,86,90,94,98,100].…”

Impressive Graft-versus-Host Disease-Free, Relapse-Free Survival in Matched Unrelated Donor Allogeneic Hematopoietic Stem Cell Transplantation Using Reduced-Intensity Conditioning and a Combination of Antithymocyte Globulin and Post-Transplantation Cyclophosphamide

“…To compare our results with those reported by Efebera et al [1], we performed a retrospective subanalysis of 121 consecutive patients who underwent 10/10 matched unrelated donor allo-HSCT under the described protocol. The median patient age was 59 years (range, 18 to 74 years).…”

“…We read with interest the recent article by Efebera et al [1]. The curative effect of reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) relies mainly on a graft-versus-leukemia effect, and the safety of in vivo T cell depletion in this setting is not well established [2,3].…”