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Impact of anti-thymocyte globulin dose for graft-versus-host disease prophylaxis in allogeneic hematopoietic cell transplantation from matched unrelated donors: a multicenter experience.
- Source :
- Annals of Hematology; Jul2021, Vol. 100 Issue 7, p1837-1847, 11p
- Publication Year :
- 2021
-
Abstract
- 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- ACUTE diseases
HEMATOPOIETIC stem cell transplantation
GRAFT versus host disease
GLOBULINS
OVERALL survival
GRAFT survival
GRAFT versus host disease prevention
RESEARCH
HOMOGRAFTS
RESEARCH methodology
ANTILYMPHOCYTIC serum
RETROSPECTIVE studies
MYCOPHENOLIC acid
DISEASE incidence
PROGNOSIS
MEDICAL cooperation
EVALUATION research
DISEASE relapse
HISTOCOMPATIBILITY
METHOTREXATE
CYCLOSPORINE
COMPARATIVE studies
KAPLAN-Meier estimator
IMMUNITY
HEMATOLOGIC malignancies
T cells
IMMUNOSUPPRESSIVE agents
PROPORTIONAL hazards models
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 09395555
- Volume :
- 100
- Issue :
- 7
- Database :
- Complementary Index
- Journal :
- Annals of Hematology
- Publication Type :
- Academic Journal
- Accession number :
- 150853636
- Full Text :
- https://doi.org/10.1007/s00277-021-04521-z