Polyclonal anti-thymocyte globulins for the prophylaxis of graft-versus-host disease after allogeneic stem cell or bone marrow transplantation in adults

Theurich, Sebastian; Fischmann, Hans; Shimabukuro‐Vornhagen, Alexander; Chemnitz, Jens M.; Scheid, Christof; Skoetz, Nicole; Bergwelt‐Baildon, Michael von

doi:10.1002/14651858.cd009159.pub2

Cited by 45 publications

(41 citation statements)

References 48 publications

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“…An important role has been suggested for antithymocyte globulin (ATG) in reducing the incidence and severity of acute and chronic GVHD with a positive rebound on all aspects of QoL. 38 Our results also seem to indicate that patients who undergo HSCT at a younger age (,15 years) are more likely to achieve better longterm HRQoL outcomes (Figure 3). Indeed, these patients basically show a physical and mental health profile that is very similar to that of their peers in the general population.…”

Section: Discussionmentioning

confidence: 50%

Long-term health-related quality of life evaluated more than 20 years after hematopoietic stem cell transplantation for thalassemia

Nasa

Caocci

Efficace

et al. 2013

Blood

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Key Points• HRQoL and lifestyles of patients transplanted more than 20 years ago for thalassemia are similar to those of the general population.• Data on HRQoL in the long term provide both physicians and patients with a more complete picture of the advantages and potential risks of HSCT.The principal aim of our study was to investigate whether patients transplanted more than 20 years ago for b-thalassemia major had a different health-related quality of life (HRQoL) compared with the general population. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) were received from 109 ex-thalassemia patients who underwent hematopoietic stem cell transplantation (HSCT) during the 1980s and 1990s. Adjusted comparisons were performed separately for patient age at HSCT and the presence or absence of graft-versus-host disease (GVHD). Sociodemographic and clinical variables were also analyzed. The median age of our cohort at HSCT and the time of the survey was 12 years (range, 1-36) and 34 years (range, 21-48), respectively, with a median follow-up age of 22.8 years (range, 11.7-30.3). Statistical analysis of data collected more than 20 years after HSCT showed that the long-term HRQoL of ex-thalassemia patients was very similar to that of the general population. Clinical meaningful differences were only found for the general health (GH) scale (-8.9; 95% CI, -15.0 to 2.7, P 5 .005). Mental health, education level, employment status, marital status, living arrangements, and birth rate were compatible with normal living patterns. The development of GVHD and older age at transplantation were important impairing factors. Additional analyses performed to evaluate HRQoL in an age-sex-matched cohort of 124 patients receiving conventional treatment of b-thalassemia revealed poorer outcomes compared with the cohort of transplanted patients. (Blood. 2013;122(13):2262-2270

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Section: Discussionmentioning

confidence: 50%

Long-term health-related quality of life evaluated more than 20 years after hematopoietic stem cell transplantation for thalassemia

Nasa

Caocci

Efficace

et al. 2013

Blood

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“…35 In the current study, the use of ATG led to a lower incidence of grade 3-4 acute GVHD, which is in line with previous studies. 6,[36][37][38] However, no correlation was found between the use of ATG and grade 2-4 GVHD, extensive chronic GVHD, and graft failure, which in previous studies were related to ATG exposure before transplantation. The absence of a correlation may be due to the relatively low incidence of chronic GVHD and graft failure in this cohort (5% and 11% for extensive chronic GVHD and graft failure, respectively).…”

Section: Discussionmentioning

confidence: 87%

Excellent T-cell reconstitution and survival depend on low ATG exposure after pediatric cord blood transplantation

Admiraal

Lindemans

Kesteren

et al. 2016

Blood

144

121

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“…Patients who received ex-vivo T cell-depleted grafts were specifically excluded, given their historically low rates of grade II-IV acute GVHD of approximately 15%; notably in this setting patients do not receive any post-transplant GVHD prophylaxis [13, 14]. In comparison, in-vivo T cell depletion with ATG administration is less effective at reducing the incidence of GVHD in recipients of conventional grafts, estimated at 28% in a recent large meta-analysis, with most patients still receiving GVHD prophylaxis with calcineurin inhibitors [15]. Thus in this study we allowed inclusion of patients receiving ATG given their continued substantial risk of developing acute GVHD.…”

Section: Methodsmentioning

confidence: 99%

Intestinal Blautia Is Associated with Reduced Death from Graft-versus-Host Disease

Jenq

Taur

Devlin

et al. 2015

Biology of Blood and Marrow Transplantation

637

542

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The relationship between intestinal microbiota composition and acute graft-versus-host disease (GVHD) after allogeneic blood/marrow transplantation (allo BMT) is not well understood. Intestinal bacteria have long been thought to contribute to GVHD pathophysiology, but recent animal studies in non-transplant settings have found that anti-inflammatory effects are mediated by certain subpopulations of intestinal commensals. Hypothesizing that a more nuanced relationship may exist between the intestinal bacteria and GVHD, we evaluated the fecal bacterial composition of 64 patients 12 days after BMT. We found that increased bacterial diversity was associated with reduced GVHD-related mortality. Furthermore, harboring increased amounts of bacteria belonging to the genus Blautia was associated with reduced GVHD lethality in this cohort and was confirmed in another independent cohort of 51 patients from the same institution. Blautia abundance was also associated with improved overall survival. We evaluated the abundance of Blautia with respect to clinical factors and found that loss of Blautia was associated with: 1) treatment with antibiotics that inhibit anaerobic bacteria and 2) receiving total parenteral nutrition (TPN) for longer durations. We conclude that increased abundance of commensal bacteria belonging to the Blautia genus is associated with reduced lethal GVHD and improved overall survival.

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Polyclonal anti-thymocyte globulins for the prophylaxis of graft-versus-host disease after allogeneic stem cell or bone marrow transplantation in adults

Cited by 45 publications

References 48 publications

Long-term health-related quality of life evaluated more than 20 years after hematopoietic stem cell transplantation for thalassemia

Long-term health-related quality of life evaluated more than 20 years after hematopoietic stem cell transplantation for thalassemia

Excellent T-cell reconstitution and survival depend on low ATG exposure after pediatric cord blood transplantation

Intestinal Blautia Is Associated with Reduced Death from Graft-versus-Host Disease

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