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Anti-thymocyte globulins for post-transplant graft-versus-host disease prophylaxis-A systematic review and meta-analysis.
Crit Rev Oncol Hematol. 2013 Oct; 88(1):178-86.CR

Abstract

BACKGROUND

Despite advances made in allogeneic hematopoietic stem cell transplantation (alloSCT), graft versus host disease (GvHD) remains a major problem. The main strategy to combat GvHD is prophylaxis and ATG plays a major role in this arena. Conflicting reports on the effectiveness of ATG on GvHD prevention prompted us to address this question by means of a systematic review and meta-analysis.

METHODS

Six prospective randomized controlled trials (RCT) comparing the addition of ATG to standard immunosuppressive regimen as GvHD prophylaxis were analyzed. All ATG preparations were considered but homogeneity in type of preparation and dosage had to be observed within each trial.

RESULTS

Our meta-analysis reveals that the incidence of grade II-IV GvHD was significantly lower in patients receiving ATG. Addition of ATG had no impact on overall survival, relapse or non-relapse mortality.

CONCLUSIONS

Based on the current level of the data analyzed in this systematic review, we cannot conclude a general recommendation for the use of ATG for GvHD prophylaxis in alloSCT. In patients who are at high risk for severe GvHD it should be considered individually. However, due to the heterogeneity of the analyzable studies it seems likely that future studies might change the results of the pooled data of this meta-analysis. In order to improve the current level of data, further randomized studies in this topic are therefore urgently warranted.

Authors+Show Affiliations

Department I of Internal Medicine, Stem Cell Transplantation Program, University Hospital of Cologne, Cologne, Germany. Electronic address: sebastian.theurich@uk-koeln.de.No 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)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

23561334

Citation

Theurich, Sebastian, et al. "Anti-thymocyte Globulins for Post-transplant Graft-versus-host Disease prophylaxis-A Systematic Review and Meta-analysis." Critical Reviews in Oncology/hematology, vol. 88, no. 1, 2013, pp. 178-86.
Theurich S, Fischmann H, Chakupurakal G, et al. Anti-thymocyte globulins for post-transplant graft-versus-host disease prophylaxis-A systematic review and meta-analysis. Crit Rev Oncol Hematol. 2013;88(1):178-86.
Theurich, S., Fischmann, H., Chakupurakal, G., Shimabukuro-Vornhagen, A., Chemnitz, J. M., Holtick, U., Rothe, A., Scheid, C., Hallek, M., Skoetz, N., & von Bergwelt-Baildon, M. (2013). Anti-thymocyte globulins for post-transplant graft-versus-host disease prophylaxis-A systematic review and meta-analysis. Critical Reviews in Oncology/hematology, 88(1), 178-86. https://doi.org/10.1016/j.critrevonc.2013.03.009
Theurich S, et al. Anti-thymocyte Globulins for Post-transplant Graft-versus-host Disease prophylaxis-A Systematic Review and Meta-analysis. Crit Rev Oncol Hematol. 2013;88(1):178-86. PubMed PMID: 23561334.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-thymocyte globulins for post-transplant graft-versus-host disease prophylaxis-A systematic review and meta-analysis. AU - Theurich,Sebastian, AU - Fischmann,Hans, AU - Chakupurakal,Geothy, AU - Shimabukuro-Vornhagen,Alexander, AU - Chemnitz,Jens M, AU - Holtick,Udo, AU - Rothe,Achim, AU - Scheid,Christof, AU - Hallek,Michael, AU - Skoetz,Nicole, AU - von Bergwelt-Baildon,Michael, Y1 - 2013/04/02/ PY - 2012/08/07/received PY - 2013/01/30/revised PY - 2013/03/12/accepted PY - 2013/4/9/entrez PY - 2013/4/9/pubmed PY - 2014/4/9/medline KW - ATG KW - Allogeneic stem cell transplantation KW - Anti-thymocyte globulins KW - Bone marrow transplantation KW - Graft-versus-host disease KW - GvHD KW - Meta-analysis KW - Systematic review SP - 178 EP - 86 JF - Critical reviews in oncology/hematology JO - Crit Rev Oncol Hematol VL - 88 IS - 1 N2 - BACKGROUND: Despite advances made in allogeneic hematopoietic stem cell transplantation (alloSCT), graft versus host disease (GvHD) remains a major problem. The main strategy to combat GvHD is prophylaxis and ATG plays a major role in this arena. Conflicting reports on the effectiveness of ATG on GvHD prevention prompted us to address this question by means of a systematic review and meta-analysis. METHODS: Six prospective randomized controlled trials (RCT) comparing the addition of ATG to standard immunosuppressive regimen as GvHD prophylaxis were analyzed. All ATG preparations were considered but homogeneity in type of preparation and dosage had to be observed within each trial. RESULTS: Our meta-analysis reveals that the incidence of grade II-IV GvHD was significantly lower in patients receiving ATG. Addition of ATG had no impact on overall survival, relapse or non-relapse mortality. CONCLUSIONS: Based on the current level of the data analyzed in this systematic review, we cannot conclude a general recommendation for the use of ATG for GvHD prophylaxis in alloSCT. In patients who are at high risk for severe GvHD it should be considered individually. However, due to the heterogeneity of the analyzable studies it seems likely that future studies might change the results of the pooled data of this meta-analysis. In order to improve the current level of data, further randomized studies in this topic are therefore urgently warranted. SN - 1879-0461 UR - https://www.unboundmedicine.com/medline/citation/23561334/Anti_thymocyte_globulins_for_post_transplant_graft_versus_host_disease_prophylaxis_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1040-8428(13)00069-3 DB - PRIME DP - Unbound Medicine ER -