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The Role of Low-dose Anti-thymocyte Globulin as Standard Prophylaxis in Mismatched and Matched Unrelated Hematopoietic Peripheral Stem Cell Transplantation for Hematologic Malignancies.
Clin Lymphoma Myeloma Leuk. 2017 10; 17(10):658-666.CL

Abstract

INTRODUCTION

Anti-thymocyte globulin (ATG)-based immunosuppressive therapy is often used in allogeneic hematopoietic cell transplantation to reduce incidence and severity of graft-versus-host disease (GVHD).

PATIENTS AND METHODS

In our observational study, ATG (rabbit, Thymoglobulin; Sanofi, 5 mg/kg) was administered as a standardized part of the conditioning in 97 patients with a median age of 34 years (range, 14-58 years), allotransplanted for hematologic malignancies from matched (8/8; n = 52) and allele or antigen mismatched (7/8; n = 43 and 6/8; n = 2) unrelated donors.

RESULTS

Five-year overall survival (OS) was 46.9%, disease-free survival was 46.5%, and treatment-related mortality was 20.6%, with a median follow-up of 29 months (range, 1-145 months). Acute GVHD (grade ≥ II) cumulative incidence was 26.9% in matched versus 50.5% in mismatched patients (P = .060), whereas extensive chronic GVHD was 45.6% versus 50%, respectively (P = .310). Five-year OS was 62.2% for the matched patients and 27.9% for the mismatched patients (P = .003) owing to a higher treatment-related mortality rate in mismatched patients (P = .032). In multivariate analysis including age, gender, time until transplantation, disease phase, mismatched donor, ABO mismatch, number of CD34+ infused, acute and chronic GVHD, the significant unfavorable factors for OS were HLA mismatch and advanced disease phase.

CONCLUSION

A relatively low-dose ATG is effective in acute GVHD prophylaxis, leading to promising survival rates in matched transplants. Further comparative studies with adjusted ATG dose depending on Human leukocyte antigen disparity or alternative donors are warranted.

Authors+Show Affiliations

Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece. Electronic address: bmt@gpapanikolaou.gr.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.Hematology Department, BMT Unit, George Papanicolaou Hospital, Thessaloniki, Greece.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28716402

Citation

Sakellari, Ioanna, et al. "The Role of Low-dose Anti-thymocyte Globulin as Standard Prophylaxis in Mismatched and Matched Unrelated Hematopoietic Peripheral Stem Cell Transplantation for Hematologic Malignancies." Clinical Lymphoma, Myeloma & Leukemia, vol. 17, no. 10, 2017, pp. 658-666.
Sakellari I, Batsis I, Bousiou Z, et al. The Role of Low-dose Anti-thymocyte Globulin as Standard Prophylaxis in Mismatched and Matched Unrelated Hematopoietic Peripheral Stem Cell Transplantation for Hematologic Malignancies. Clin Lymphoma Myeloma Leuk. 2017;17(10):658-666.
Sakellari, I., Batsis, I., Bousiou, Z., Mallouri, D., Constantinou, V., Gavriilaki, E., Smias, C., Yannaki, E., Kaloyannidis, P., Papaioannou, G., Stavroyianni, N., Syrigou, A., Sotiropoulos, D., Fylaktou, A., Tsompanakou, A., Saloum, R., & Anagnostopoulos, A. (2017). The Role of Low-dose Anti-thymocyte Globulin as Standard Prophylaxis in Mismatched and Matched Unrelated Hematopoietic Peripheral Stem Cell Transplantation for Hematologic Malignancies. Clinical Lymphoma, Myeloma & Leukemia, 17(10), 658-666. https://doi.org/10.1016/j.clml.2017.06.008
Sakellari I, et al. The Role of Low-dose Anti-thymocyte Globulin as Standard Prophylaxis in Mismatched and Matched Unrelated Hematopoietic Peripheral Stem Cell Transplantation for Hematologic Malignancies. Clin Lymphoma Myeloma Leuk. 2017;17(10):658-666. PubMed PMID: 28716402.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Role of Low-dose Anti-thymocyte Globulin as Standard Prophylaxis in Mismatched and Matched Unrelated Hematopoietic Peripheral Stem Cell Transplantation for Hematologic Malignancies. AU - Sakellari,Ioanna, AU - Batsis,Ioannis, AU - Bousiou,Zoi, AU - Mallouri,Despina, AU - Constantinou,Varnavas, AU - Gavriilaki,Eleni, AU - Smias,Christos, AU - Yannaki,Evangelia, AU - Kaloyannidis,Panayotis, AU - Papaioannou,Giorgos, AU - Stavroyianni,Niki, AU - Syrigou,Antonia, AU - Sotiropoulos,Damianos, AU - Fylaktou,Asimina, AU - Tsompanakou,Aliki, AU - Saloum,Riad, AU - Anagnostopoulos,Achilles, Y1 - 2017/06/29/ PY - 2017/01/23/received PY - 2017/06/04/revised PY - 2017/06/08/accepted PY - 2017/7/19/pubmed PY - 2018/5/31/medline PY - 2017/7/19/entrez KW - Anti-thymocyte globulin KW - Graft-versus-host disease KW - HLA disparity KW - Hematologic malignancies KW - Survival KW - Unrelated hematopoietic cell transplantation SP - 658 EP - 666 JF - Clinical lymphoma, myeloma & leukemia JO - Clin Lymphoma Myeloma Leuk VL - 17 IS - 10 N2 - INTRODUCTION: Anti-thymocyte globulin (ATG)-based immunosuppressive therapy is often used in allogeneic hematopoietic cell transplantation to reduce incidence and severity of graft-versus-host disease (GVHD). PATIENTS AND METHODS: In our observational study, ATG (rabbit, Thymoglobulin; Sanofi, 5 mg/kg) was administered as a standardized part of the conditioning in 97 patients with a median age of 34 years (range, 14-58 years), allotransplanted for hematologic malignancies from matched (8/8; n = 52) and allele or antigen mismatched (7/8; n = 43 and 6/8; n = 2) unrelated donors. RESULTS: Five-year overall survival (OS) was 46.9%, disease-free survival was 46.5%, and treatment-related mortality was 20.6%, with a median follow-up of 29 months (range, 1-145 months). Acute GVHD (grade ≥ II) cumulative incidence was 26.9% in matched versus 50.5% in mismatched patients (P = .060), whereas extensive chronic GVHD was 45.6% versus 50%, respectively (P = .310). Five-year OS was 62.2% for the matched patients and 27.9% for the mismatched patients (P = .003) owing to a higher treatment-related mortality rate in mismatched patients (P = .032). In multivariate analysis including age, gender, time until transplantation, disease phase, mismatched donor, ABO mismatch, number of CD34+ infused, acute and chronic GVHD, the significant unfavorable factors for OS were HLA mismatch and advanced disease phase. CONCLUSION: A relatively low-dose ATG is effective in acute GVHD prophylaxis, leading to promising survival rates in matched transplants. Further comparative studies with adjusted ATG dose depending on Human leukocyte antigen disparity or alternative donors are warranted. SN - 2152-2669 UR - https://www.unboundmedicine.com/medline/citation/28716402/The_Role_of_Low_dose_Anti_thymocyte_Globulin_as_Standard_Prophylaxis_in_Mismatched_and_Matched_Unrelated_Hematopoietic_Peripheral_Stem_Cell_Transplantation_for_Hematologic_Malignancies_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2152-2650(17)30096-4 DB - PRIME DP - Unbound Medicine ER -