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Antithymocyte globulin for acute-graft-versus-host-disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a systematic review.
Leukemia. 2012 Apr; 26(4):582-8.L

Abstract

Graft-versus-host-disease (GVHD) is a major complication associated with allogeneic hematopoietic cell transplantation (allo-HCT). Antithymocyte globulin (ATG) is recommended for GVHD prophylaxis following allo-HCT, however, evidence on efficacy of ATG is conflicting. Accordingly, we undertook a systematic review. All phase III randomized controlled trials (RCTs) comparing ATG versus control for prevention of GVHD in patients undergoing allo-HCT were eligible. Medline and Cochrane databases were searched. Data on methodological quality, benefits and harms were extracted for each trial and pooled under a random effects model. Seven RCTs enrolling 733 patients met inclusion criteria. Pooled results showed no difference for overall survival with use of ATG (hazard ratio was 0.91; 95% confidence intervals (CI), 0.75-1.10; P = 0.32). There was a significant benefit for prevention of grade III/IV acute GVHD (risk ratio (RR) = 0.51; 95% CI, 0.27-0.94; P = 0.03). There was no benefit associated with ATG use for prevention of either grade II (RR = 0.79; 95% CI, 0.48-1.30; P = 0.35) or grade I acute GVHD (RR = 1.42; 95% CI, 0.75-2.69; P = 0.28). Use of ATG was not associated with significant reduction in non-relapse mortality (RR = 0.74; 95% CI, 0.53-1.03; P = 0.08). Future trials with adequate sample size are required to provide more definitive answers.

Authors+Show Affiliations

Center and Division for Evidence Based Medicine and Health Outcomes Research, Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL 33612, USA. akumar1@hsc.usf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

22182922

Citation

Kumar, A, et al. "Antithymocyte Globulin for Acute-graft-versus-host-disease Prophylaxis in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: a Systematic Review." Leukemia, vol. 26, no. 4, 2012, pp. 582-8.
Kumar A, Mhaskar AR, Reljic T, et al. Antithymocyte globulin for acute-graft-versus-host-disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a systematic review. Leukemia. 2012;26(4):582-8.
Kumar, A., Mhaskar, A. R., Reljic, T., Mhaskar, R. S., Kharfan-Dabaja, M. A., Anasetti, C., Mohty, M., & Djulbegovic, B. (2012). Antithymocyte globulin for acute-graft-versus-host-disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a systematic review. Leukemia, 26(4), 582-8. https://doi.org/10.1038/leu.2011.349
Kumar A, et al. Antithymocyte Globulin for Acute-graft-versus-host-disease Prophylaxis in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: a Systematic Review. Leukemia. 2012;26(4):582-8. PubMed PMID: 22182922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antithymocyte globulin for acute-graft-versus-host-disease prophylaxis in patients undergoing allogeneic hematopoietic cell transplantation: a systematic review. AU - Kumar,A, AU - Mhaskar,A R, AU - Reljic,T, AU - Mhaskar,R S, AU - Kharfan-Dabaja,M A, AU - Anasetti,C, AU - Mohty,M, AU - Djulbegovic,B, Y1 - 2011/12/20/ PY - 2011/12/21/entrez PY - 2011/12/21/pubmed PY - 2012/6/5/medline SP - 582 EP - 8 JF - Leukemia JO - Leukemia VL - 26 IS - 4 N2 - Graft-versus-host-disease (GVHD) is a major complication associated with allogeneic hematopoietic cell transplantation (allo-HCT). Antithymocyte globulin (ATG) is recommended for GVHD prophylaxis following allo-HCT, however, evidence on efficacy of ATG is conflicting. Accordingly, we undertook a systematic review. All phase III randomized controlled trials (RCTs) comparing ATG versus control for prevention of GVHD in patients undergoing allo-HCT were eligible. Medline and Cochrane databases were searched. Data on methodological quality, benefits and harms were extracted for each trial and pooled under a random effects model. Seven RCTs enrolling 733 patients met inclusion criteria. Pooled results showed no difference for overall survival with use of ATG (hazard ratio was 0.91; 95% confidence intervals (CI), 0.75-1.10; P = 0.32). There was a significant benefit for prevention of grade III/IV acute GVHD (risk ratio (RR) = 0.51; 95% CI, 0.27-0.94; P = 0.03). There was no benefit associated with ATG use for prevention of either grade II (RR = 0.79; 95% CI, 0.48-1.30; P = 0.35) or grade I acute GVHD (RR = 1.42; 95% CI, 0.75-2.69; P = 0.28). Use of ATG was not associated with significant reduction in non-relapse mortality (RR = 0.74; 95% CI, 0.53-1.03; P = 0.08). Future trials with adequate sample size are required to provide more definitive answers. SN - 1476-5551 UR - https://www.unboundmedicine.com/medline/citation/22182922/Antithymocyte_globulin_for_acute_graft_versus_host_disease_prophylaxis_in_patients_undergoing_allogeneic_hematopoietic_cell_transplantation:_a_systematic_review_ L2 - https://doi.org/10.1038/leu.2011.349 DB - PRIME DP - Unbound Medicine ER -