Tags

Type your tag names separated by a space and hit enter

Anti-thymocyte globulin overcomes the negative impact of HLA mismatching in transplantation from unrelated donors.
Exp Hematol. 2008 Aug; 36(8):1047-54.EH

Abstract

OBJECTIVE

About one third of patients requiring allogeneic hematopoetic stem cell transplantation (HSCT) would not find a matched sibling or alternative donor. Allogeneic HSCT from matched unrelated and mismatched donors carries an increased risk of graft-vs-host disease (GVHD) and transplant-related mortality (TRM).

MATERIALS AND METHODS

We used anti-thymocyte globulin (ATG-Fresenius) at a median dose of 90 mg/kg body weight as part of a total body irradiation or busulfan-based conditioning regimen for prevention of serious GVHD. All patients received cyclosporine A and short-course methotrexate. We compared outcomes of 65 recipients of human leukocyte antigen (HLA)-mismatched unrelated grafts and 194 recipients of HLA-matched unrelated grafts. Mismatches involved one or two loci. Both groups were comparable in age, graft source, diagnosis, stage of disease, and conditioning regimen, and differed only in dose of ATG administered.

RESULTS

For matched and mismatched transplants, respectively, there was no significant difference in graft failure (0.5% vs 3%; p = 0.16), in the cumulative incidence of grade II to IV acute GVHD (45% vs 35%; p = 0.14) and no difference in overall chronic GVHD (42% vs 40%; p = 0.68). Estimated overall survival (OS) and disease-free survival (DFS) at 5 years were 55% vs 50% (p = 0.99) and 47% vs 47% (p = 1.0), respectively. The cumulative incidence of relapse and TRM at 5 years were 24% vs 25% (p = 0.63), and 29% vs 27% (p = 0.59), respectively.

CONCLUSION

Inclusion of ATG-Fresenius in the conditioning regimen permits HSCT from mismatched unrelated donors without excess TRM and GVHD, resulting in identical OS and DFS of recipients of HLA-matched and HLA-mismatched grafts.

Authors+Show Affiliations

Department of Stem Cell Transplantation, University Medical Center Hamburg, Hamburg, Germany. ayuketan@uke.uni-hamburg.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

18456390

Citation

Ayuk, Francis, et al. "Anti-thymocyte Globulin Overcomes the Negative Impact of HLA Mismatching in Transplantation From Unrelated Donors." Experimental Hematology, vol. 36, no. 8, 2008, pp. 1047-54.
Ayuk F, Diyachenko G, Zabelina T, et al. Anti-thymocyte globulin overcomes the negative impact of HLA mismatching in transplantation from unrelated donors. Exp Hematol. 2008;36(8):1047-54.
Ayuk, F., Diyachenko, G., Zabelina, T., Panse, J., Wolschke, C., Eiermann, T., Binder, T., Fehse, B., Erttmann, R., Kabisch, H., Bacher, U., Kröger, N., & Zander, A. R. (2008). Anti-thymocyte globulin overcomes the negative impact of HLA mismatching in transplantation from unrelated donors. Experimental Hematology, 36(8), 1047-54. https://doi.org/10.1016/j.exphem.2008.03.011
Ayuk F, et al. Anti-thymocyte Globulin Overcomes the Negative Impact of HLA Mismatching in Transplantation From Unrelated Donors. Exp Hematol. 2008;36(8):1047-54. PubMed PMID: 18456390.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-thymocyte globulin overcomes the negative impact of HLA mismatching in transplantation from unrelated donors. AU - Ayuk,Francis, AU - Diyachenko,Galina, AU - Zabelina,Tatjana, AU - Panse,Jens, AU - Wolschke,Christine, AU - Eiermann,Thomas, AU - Binder,Thomas, AU - Fehse,Boris, AU - Erttmann,Rudolf, AU - Kabisch,Hartmut, AU - Bacher,Ulrike, AU - Kröger,Nicolaus, AU - Zander,Axel R, Y1 - 2008/05/05/ PY - 2007/12/15/received PY - 2008/01/31/revised PY - 2008/03/03/accepted PY - 2008/5/6/pubmed PY - 2008/9/20/medline PY - 2008/5/6/entrez SP - 1047 EP - 54 JF - Experimental hematology JO - Exp Hematol VL - 36 IS - 8 N2 - OBJECTIVE: About one third of patients requiring allogeneic hematopoetic stem cell transplantation (HSCT) would not find a matched sibling or alternative donor. Allogeneic HSCT from matched unrelated and mismatched donors carries an increased risk of graft-vs-host disease (GVHD) and transplant-related mortality (TRM). MATERIALS AND METHODS: We used anti-thymocyte globulin (ATG-Fresenius) at a median dose of 90 mg/kg body weight as part of a total body irradiation or busulfan-based conditioning regimen for prevention of serious GVHD. All patients received cyclosporine A and short-course methotrexate. We compared outcomes of 65 recipients of human leukocyte antigen (HLA)-mismatched unrelated grafts and 194 recipients of HLA-matched unrelated grafts. Mismatches involved one or two loci. Both groups were comparable in age, graft source, diagnosis, stage of disease, and conditioning regimen, and differed only in dose of ATG administered. RESULTS: For matched and mismatched transplants, respectively, there was no significant difference in graft failure (0.5% vs 3%; p = 0.16), in the cumulative incidence of grade II to IV acute GVHD (45% vs 35%; p = 0.14) and no difference in overall chronic GVHD (42% vs 40%; p = 0.68). Estimated overall survival (OS) and disease-free survival (DFS) at 5 years were 55% vs 50% (p = 0.99) and 47% vs 47% (p = 1.0), respectively. The cumulative incidence of relapse and TRM at 5 years were 24% vs 25% (p = 0.63), and 29% vs 27% (p = 0.59), respectively. CONCLUSION: Inclusion of ATG-Fresenius in the conditioning regimen permits HSCT from mismatched unrelated donors without excess TRM and GVHD, resulting in identical OS and DFS of recipients of HLA-matched and HLA-mismatched grafts. SN - 0301-472X UR - https://www.unboundmedicine.com/medline/citation/18456390/Anti_thymocyte_globulin_overcomes_the_negative_impact_of_HLA_mismatching_in_transplantation_from_unrelated_donors_ DB - PRIME DP - Unbound Medicine ER -