The effect of equine antithymocyte globulin on the outcomes of reduced intensity conditioning for AML

Hagen, Patrick; Wagner, John E.; DeFor, Todd E.; Dolan, Michelle; Arora, Mukta; Warlick, Erica D.; Weisdorf, Daniel J.; Brunstein, Claudio G.

doi:10.1038/bmt.2014.183

Cited by 11 publications

(6 citation statements)

References 29 publications

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“…Interestingly, horse ATG appears to be more efficacious than rabbit ATG when treating aplastic anemia [6], though not all studies confirm this [7]. For prophylaxis of GVHD, rabbit ATG is efficacious whereas horse ATG is not efficacious [8][9][10]. In the randomized study of horse ATG prophylaxis in patients with aplastic anemia, the incidence of cGVHD was even higher in the horse ATG arm compared with the no ATG arm, though this was not statistically significant [8].…”

Section: Atg Formulationsmentioning

confidence: 73%

Rabbit Anti–T Cell Globulin in Allogeneic Hematopoietic Cell Transplantation

Storek

Mohty²,

Boelens

2015

Biology of Blood and Marrow Transplantation

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Anti-T cell globulin (ATG) is polyclonal IgG from rabbits immunized with human thymocytes or a human T cell line. Prophylaxis using ATG infused with conditioning for adult marrow or blood stem cell transplantation reduces both acute and chronic graft-versus-host disease (GVHD). However, ATG is not or minimally efficacious in steroid refractory GVHD treatment. Regarding preemptive therapy, ATG is promising; however, further work is needed on establishing adequate biomarkers to be used as triggers for preemptive therapy before it can be used routinely. Relapse is not increased by ATG, except possibly in the setting of reduced-intensity conditioning. Infections are probably increased when using high but not low-dose ATG, except for Epstein-Barr virus-driven post-transplantation lymphoproliferative disorder, which may be increased even with low-dose ATG. Survival is not improved with ATG; however, survival free of immunosuppressive therapy is improved. Pharmacokinetics of ATG are highly variable, resulting in highly variable areas under the time-concentration curves. Optimized dosing of ATG might improve transplantation outcomes. In conclusion, ATG reduces GVHD and, thus, may improve quality of life, without compromising survival.

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Section: Atg Formulationsmentioning

confidence: 73%

Rabbit Anti–T Cell Globulin in Allogeneic Hematopoietic Cell Transplantation

Storek

Mohty²,

Boelens

2015

Biology of Blood and Marrow Transplantation

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“…Although ATG was omitted in conditioning, Takahashi et al [8,21] reported that the cumulative incidences of grades III and IV aGVHD and extensive-type cGVHD among CBT recipients were significantly lower than those among related or unrelated bone marrow/peripheral blood stem cell transplant recipients, despite the higher HLA mismatching rate in CBT. Hagen et al [22] retrospectively studied the effect of ATG in 144 AML patients (34 of whom received ATG) undergoing RIC CBT or HLA-matched sibling peripheral blood stem cell transplantations, and found that there were no differences in aGVHD and cGVHD between ATG and non-ATG patients. A more recent study [23] also showed that the omission of ATG before double CBT with RIC did not lead to an increased incidence of grade III and IV aGVHD (only 14%).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Conditioning Regimens with or without Antithymocyte Globulin for Unrelated Cord Blood Transplantation in Children with High-Risk or Advanced Hematological Malignancies

Zheng

Zuo

Fang

et al. 2015

Biology of Blood and Marrow Transplantation

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The role and potential efficacy of antithymocyte globulin (ATG) in patients receiving cord blood transplantation (CBT) remain controversial. We retrospectively evaluated the effect of ATG on patient outcomes in 207 children with high-risk or advanced hematological malignancies at 8 child blood disease centers in China. The cumulative incidence of platelet recovery on day 100 was significantly lower in the ATG cohort compared with the non-ATG cohort (77.3% versus 89.8%) (P = .046). There was no significant difference in the incidence of grade II to IV acute and chronic graft-versus-host disease (GVHD), and transplantation-related mortality (TRM) between the 2 groups (P = .76, P = .57, and P = .46, respectively). The incidence of CMV infection was significantly higher among the ATG group compared with that among the non-ATG group (P = .003). The 5-year cumulative incidence of relapse was significantly higher in the ATG cohort (30.7% versus 15.4%) (P = .009). Overall survival in the non-ATG group was slightly higher than that of the ATG cohort (64.1% versus 52.1%, P = .093) and leukemia-free survival in the non-ATG cohort was significantly higher than in the ATG cohort (56.6% versus 37.7%, P = .015). Our study demonstrated that, for high-risk or advanced childhood hematological malignancies receiving unrelated CBT, patients who received conditioning that omitted ATG had a faster platelet recovery, a comparable GVHD and TRM, a significantly lower relapse risk, and an improved long-term survival compared with those patients who received ATG in the conditioning.

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“…Infectious prophylaxis, other supportive care measures, and GVHD prophylaxis have been described. 24, 26, 27 …”

Section: Methodsmentioning

confidence: 99%

Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival

Lunde

Dasaraju

Cao

et al. 2015

Bone Marrow Transplant

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Although hemorrhagic cystitis (HC) is a common complication of allogeneic hematopoietic cell transplantation (alloHCT), its risk factors and effects on survival are not well-known. We evaluated HC in a large cohort (n=1321, 2003 – 2012) receiving alloHCT from all graft sources, including umbilical cord blood (UCB). We compared HC patients with non-HC (control) patients and examined clinical variables at HC onset and resolution. Of these 1321 patients, 219 (16.6%) developed HC at a median of 22 days after alloHCT. BK viruria was detected in 90% of 109 tested HC patients. Median duration of HC was 27 days. At the time of HC diagnosis, acute graft-versus-host disease (GVHD), fever, severe thrombocytopenia, and steroid use were more frequent than at the time of HC resolution. In univariate analysis, male sex, age <20 years, myeloablative conditioning with cyclophosphamide and acute GVHD were associated with HC. In multivariate analysis, HC was significantly more common in males and HLA-mismatched UCB graft recipients. Severe grade HC (grade III–IV) was associated with increased treatment-related mortality (TRM) but not with overall survival at 1 year. HC remains hazardous and therefore better prophylaxis and early interventions to limit its severity are still needed.

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The effect of equine antithymocyte globulin on the outcomes of reduced intensity conditioning for AML

Cited by 11 publications

References 29 publications

Rabbit Anti–T Cell Globulin in Allogeneic Hematopoietic Cell Transplantation

Rabbit Anti–T Cell Globulin in Allogeneic Hematopoietic Cell Transplantation

Comparison of Conditioning Regimens with or without Antithymocyte Globulin for Unrelated Cord Blood Transplantation in Children with High-Risk or Advanced Hematological Malignancies

Hemorrhagic cystitis after allogeneic hematopoietic cell transplantation: risk factors, graft source and survival

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