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Improved nonrelapse mortality and infection rate with lower dose of antithymocyte globulin in patients undergoing reduced-intensity conditioning allogeneic transplantation for hematologic malignancies.
Biol Blood Marrow Transplant. 2009 Nov; 15(11):1422-30.BB

Abstract

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.

Authors+Show Affiliations

Division of Hematology/Oncology, Blood and Marrow Transplantation Section, and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA. mehdi.hamadani@gmail.comNo 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

19822302

Citation

Hamadani, Mehdi, et al. "Improved Nonrelapse Mortality and Infection Rate With Lower Dose of Antithymocyte Globulin in Patients Undergoing Reduced-intensity Conditioning Allogeneic Transplantation for Hematologic Malignancies." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 15, no. 11, 2009, pp. 1422-30.
Hamadani M, Blum W, Phillips G, et al. Improved nonrelapse mortality and infection rate with lower dose of antithymocyte globulin in patients undergoing reduced-intensity conditioning allogeneic transplantation for hematologic malignancies. Biol Blood Marrow Transplant. 2009;15(11):1422-30.
Hamadani, M., Blum, W., Phillips, G., Elder, P., Andritsos, L., Hofmeister, C., O'Donnell, L., Klisovic, R., Penza, S., Garzon, R., Krugh, D., Lin, T., Bechtel, T., Benson, D. M., Byrd, J. C., Marcucci, G., & Devine, S. M. (2009). Improved nonrelapse mortality and infection rate with lower dose of antithymocyte globulin in patients undergoing reduced-intensity conditioning allogeneic transplantation for hematologic malignancies. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 15(11), 1422-30. https://doi.org/10.1016/j.bbmt.2009.07.006
Hamadani M, et al. Improved Nonrelapse Mortality and Infection Rate With Lower Dose of Antithymocyte Globulin in Patients Undergoing Reduced-intensity Conditioning Allogeneic Transplantation for Hematologic Malignancies. Biol Blood Marrow Transplant. 2009;15(11):1422-30. PubMed PMID: 19822302.
* Article titles in AMA citation format should be in sentence-case
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 -