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Low-dose alemtuzumab vs. standard policy for prevention of graft-versus-host disease in unrelated and related allogeneic stem cell transplantation-a matched pair analysis.
Ann Hematol. 2013 Jul; 92(7):945-52.AH

Abstract

Antibody-mediated in vivo T cell depletion is common prior to unrelated (URD) or mismatched allogeneic stem cell transplantation (alloSCT) and optional in HLA-identical sibling (FAM) alloSCT. While anti-thymocyte globulin (ATG) is the current standard, alemtuzumab is an alternative. The optimal dose of alemtuzumab has not been defined. This retrospective analysis compares low-dose alemtuzumab with ATG in URD alloSCT and with no antibody in FAM alloSCT. Twenty-eight patients treated with alemtuzumab (10 mg; HLA mismatch, 20 mg) were matched to 28 patients who have either received ATG (URD) or no antibody (noAB) according to disease, disease stage, age, transplant type and risk state. Both groups were compared for engraftment, outcome, disease-free (DFS) and overall survival (OS), graft-versus-host disease (GvHD), freedom from GvHD (ffGvHD) and transplant-related mortality (TRM). No significant differences were found between the groups for leukocyte engraftment, GvHD, ffGvHD, TRM, DFS and OS. There was a trend for reduction of cGvHD by alemtuzumab (p = 0.05). A transplant-type stratified subanalysis consolidated equivalency of alemtuzumab and ATG in URD-SCT and indicates possible superiority of low-dose alemtuzumab compared to noAB in FAM-SCT. Low-dose alemtuzumab, as part of conditioning regimen prior to alloSCT, is safe and comparable to standard ATG. Prospective trials, particularly comparing alemtuzumab vs. noAB in FAM alloSCT, should be conducted.

Authors+Show Affiliations

Department of Internal Medicine C (Haematology and Oncology, Marrow Transplantation), Ernst-Moritz-Arndt-University Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.No 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

Language

eng

PubMed ID

23463451

Citation

Busemann, Christoph, et al. "Low-dose Alemtuzumab Vs. Standard Policy for Prevention of Graft-versus-host Disease in Unrelated and Related Allogeneic Stem Cell Transplantation-a Matched Pair Analysis." Annals of Hematology, vol. 92, no. 7, 2013, pp. 945-52.
Busemann C, Neumann T, Schulze M, et al. Low-dose alemtuzumab vs. standard policy for prevention of graft-versus-host disease in unrelated and related allogeneic stem cell transplantation-a matched pair analysis. Ann Hematol. 2013;92(7):945-52.
Busemann, C., Neumann, T., Schulze, M., Klenner, A., Thiele, T., Greinacher, A., Dölken, G., & Krüger, W. H. (2013). Low-dose alemtuzumab vs. standard policy for prevention of graft-versus-host disease in unrelated and related allogeneic stem cell transplantation-a matched pair analysis. Annals of Hematology, 92(7), 945-52. https://doi.org/10.1007/s00277-013-1714-4
Busemann C, et al. Low-dose Alemtuzumab Vs. Standard Policy for Prevention of Graft-versus-host Disease in Unrelated and Related Allogeneic Stem Cell Transplantation-a Matched Pair Analysis. Ann Hematol. 2013;92(7):945-52. PubMed PMID: 23463451.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low-dose alemtuzumab vs. standard policy for prevention of graft-versus-host disease in unrelated and related allogeneic stem cell transplantation-a matched pair analysis. AU - Busemann,Christoph, AU - Neumann,Thomas, AU - Schulze,Meike, AU - Klenner,Anne, AU - Thiele,Thomas, AU - Greinacher,Andreas, AU - Dölken,Gottfried, AU - Krüger,William H, Y1 - 2013/03/05/ PY - 2012/08/16/received PY - 2013/02/19/accepted PY - 2013/3/7/entrez PY - 2013/3/7/pubmed PY - 2013/8/21/medline SP - 945 EP - 52 JF - Annals of hematology JO - Ann Hematol VL - 92 IS - 7 N2 - Antibody-mediated in vivo T cell depletion is common prior to unrelated (URD) or mismatched allogeneic stem cell transplantation (alloSCT) and optional in HLA-identical sibling (FAM) alloSCT. While anti-thymocyte globulin (ATG) is the current standard, alemtuzumab is an alternative. The optimal dose of alemtuzumab has not been defined. This retrospective analysis compares low-dose alemtuzumab with ATG in URD alloSCT and with no antibody in FAM alloSCT. Twenty-eight patients treated with alemtuzumab (10 mg; HLA mismatch, 20 mg) were matched to 28 patients who have either received ATG (URD) or no antibody (noAB) according to disease, disease stage, age, transplant type and risk state. Both groups were compared for engraftment, outcome, disease-free (DFS) and overall survival (OS), graft-versus-host disease (GvHD), freedom from GvHD (ffGvHD) and transplant-related mortality (TRM). No significant differences were found between the groups for leukocyte engraftment, GvHD, ffGvHD, TRM, DFS and OS. There was a trend for reduction of cGvHD by alemtuzumab (p = 0.05). A transplant-type stratified subanalysis consolidated equivalency of alemtuzumab and ATG in URD-SCT and indicates possible superiority of low-dose alemtuzumab compared to noAB in FAM-SCT. Low-dose alemtuzumab, as part of conditioning regimen prior to alloSCT, is safe and comparable to standard ATG. Prospective trials, particularly comparing alemtuzumab vs. noAB in FAM alloSCT, should be conducted. SN - 1432-0584 UR - https://www.unboundmedicine.com/medline/citation/23463451/Low_dose_alemtuzumab_vs__standard_policy_for_prevention_of_graft_versus_host_disease_in_unrelated_and_related_allogeneic_stem_cell_transplantation_a_matched_pair_analysis_ L2 - https://dx.doi.org/10.1007/s00277-013-1714-4 DB - PRIME DP - Unbound Medicine ER -