Impact of antithymocyte globulin doses in reduced intensity conditioning before allogeneic transplantation from matched sibling donor for patients with acute myeloid leukemia: a report from the acute leukemia working party of European group of Bone Marrow Transplantation.
Bone Marrow Transplant
; 53(4): 431-437, 2018 04.
Article
em En
| MEDLINE
| ID: mdl-29330391
ABSTRACT
Antithymocyte globulin (ATG) is commonly used for graft-vs.-host disease (GVHD) prophylaxis in unrelated donor allogeneic transplantation (Allo-HSCT). However, its use is still controversial in matched sibling donor (MSD) Allo-HSCT, notably after reduced intensity conditioning (RIC). ATG dose may influence the outcome, explaining in part the discordant conclusions in MSD Allo-HSCT. We, therefore, analyzed the impact of ATG doses in patients with acute myeloid leukemia in first complete remission undergoing RIC Allo-HSCT from a MSD. We analyzed 234 patients from the EBMT registry and compared outcome according to given ATG dose (high dose ≥ 6 mg/kg, n = 39 or low dose < 6 mg/kg, n = 195). No difference was found in the cumulative incidence of acute (grade 2-4 high dose vs. low dose 21% vs. 13%, p = 0.334; adjusted hazard ratio (HR) 1.20, p = 0.712) and chronic GVHD (extensive high dose vs. low dose 19% vs. 18%, p = 0.897; adjusted HR 1.01, p = 0.980). In contrast, high dose of ATG significantly increased the incidence of relapse (52% vs. 26%, p = 0.011; adjusted HR 1.31, p = 0.001) leading to impaired outcome (HR progression-free survival (PFS) 1.23, p = 0.002; HR overall survival (OS) 1.17, p = 0.029; HR GVHD and relapse-free survival (GRFS) 1.20, p = 0.005). We conclude that an ATG dose <6 mg/kg is sufficient for GVHD prophylaxis, while higher doses impair disease control and outcome.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
1_ASSA2030
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2_ODS3
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6_ODS3_enfermedades_notrasmisibles
Base de dados:
MEDLINE
Assunto principal:
Doadores de Tecidos
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Leucemia Mieloide Aguda
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Transplante de Células-Tronco Hematopoéticas
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Condicionamento Pré-Transplante
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Soro Antilinfocitário
Tipo de estudo:
Observational_studies
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Risk_factors_studies
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Bone Marrow Transplant
Ano de publicação:
2018
Tipo de documento:
Article