TY - JOUR T1 - Improved nonrelapse mortality and infection rate with lower dose of antithymocyte globulin in patients undergoing reduced-intensity conditioning allogeneic transplantation for hematologic malignancies. AU - Hamadani,Mehdi, AU - Blum,William, AU - Phillips,Gary, AU - Elder,Patrick, AU - Andritsos,Leslie, AU - Hofmeister,Craig, AU - O'Donnell,Lynn, AU - Klisovic,Rebecca, AU - Penza,Sam, AU - Garzon,Ramiro, AU - Krugh,David, AU - Lin,Thomas, AU - Bechtel,Thomas, AU - Benson,Don M, AU - Byrd,John C, AU - Marcucci,Guido, AU - Devine,Steven M, Y1 - 2009/09/01/ PY - 2009/06/13/received PY - 2009/07/07/accepted PY - 2009/10/14/entrez PY - 2009/10/14/pubmed PY - 2009/12/16/medline SP - 1422 EP - 30 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 15 IS - 11 N2 - We sought to reduce the risk of infectious complications and nonrelapse mortality (NRM) associated with the use of antithymocyte globulin (ATG) without compromising control of acute graft-versus-host disease (aGVHD) in patients undergoing reduced-intensity conditioning (RIC) transplantation. As part of an ongoing quality improvement effort, we lowered the dose of rabbit ATG from 7.5 mg/kg of ATG (R-ATG) (n = 39) to 6.0 mg/kg of ATG (r-ATG) (n = 33) in association with fludarabine (Flu) and busulfan (BU) RIC transplantation and then monitored patients for adverse events, relapse, and survival. Of the 72 mostly high risk (82%) patients studied, 89% received unrelated donor allografts, 25% of which were HLA-mismatched. No differences in posttransplantation full donor-cell chimerism rates were observed between the 2 ATG-dose groups (P > .05). When R-ATG versus r-ATG patients were compared, we observed no significant difference in the cumulative incidence of grade II-IV aGVHD (32% versus 27%; P = .73) or grade III-IV aGVHD (23% versus 11%; P = .28). However, the r-ATG group had significantly less cytomegalovirus (CMV) reactivation (64% versus 30%; P = .005) and bacterial infections (56% versus 18%; P = .001), a better 1-year cumulative incidence of NRM (18% versus 3%; P = .03), and a trend for better 1-year overall survival (OS) (64% versus 84%; P = .07) compared to R-ATG patients. A seemingly modest reduction in the dose of rabbit ATG did not compromise control of aGVHD or achievement of donor chimerism, but led to a significant decrease in the risk of serious infections and NRM in high-risk RIC allograft recipients. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/19822302/Improved_nonrelapse_mortality_and_infection_rate_with_lower_dose_of_antithymocyte_globulin_in_patients_undergoing_reduced_intensity_conditioning_allogeneic_transplantation_for_hematologic_malignancies_ DB - PRIME DP - Unbound Medicine ER -