Comparison of Two Doses of Antithymocyte Globulin in Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation.
Biol Blood Marrow Transplant
; 25(10): 1993-2001, 2019 10.
Article
em En
| MEDLINE
| ID: mdl-31229641
ABSTRACT
The appropriate dose of antithymocyte globulin (ATG) to be used in reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (allo-HSCT) is yet to be determined. We retrospectively analyzed the outcomes of patients who underwent unrelated or mismatch related RIC allo-HSCT for hematologic malignancies and received r-ATG (4.5 mg/kg, 141 patients) versus R-ATG (6 mg/kg, 216 patients). There was a higher incidence of cytomegalovirus (P < .001) and Epstein-Barr virus viremia (P =.03) in the R-ATG group than in the r-ATG group. The cumulative incidences of acute graft-versus-host disease (aGVHD) grades II to IV at day 180 in the r-ATG and R-ATG groups were 59% and 44% (Pâ¯=â¯.006) and grades III to IV 20% and 12% (Pâ¯=â¯.029), respectively. In multivariable models adjusting for disease diagnosis, the risk of aGVHD grades III to IV did not reach statistical significance (Pâ¯=â¯.087). The respective cumulative incidences of chronic GVHD in the r-ATG and R-ATG groups were 26% and 15% (Pâ¯=â¯.10), respectively. There were no significant differences in relapse rate (Pâ¯=â¯.24), nonrelapse mortality (Pâ¯=â¯.96), progression-free survival (Pâ¯=â¯.24), overall survival (Pâ¯=â¯.70), and GVHD-free relapse-free survival (Pâ¯=â¯.24). In this retrospective analysis, aGVHD incidence was higher in those treated with r-ATG compared with R-ATG, but this did not translate into significant differences of clinical outcome. Given the increasing use of RIC allo-HSCT for treating malignant hematologic conditions, the correct dose and schedule of ATG administration should be defined by prospective randomized controlled trials.
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Base de dados:
MEDLINE
Assunto principal:
Transplante Homólogo
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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
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:
Biol Blood Marrow Transplant
Assunto da revista:
HEMATOLOGIA
/
TRANSPLANTE
Ano de publicação:
2019
Tipo de documento:
Article