Does anti-thymocyte globulin have a place in busulfan/fludarabine conditioning for matched related donor hematopoietic stem cell transplantation?

BACKGROUND/AIMS: There is controversy about the prophylactic effect of anti-thymocyte globulin (ATG) on graft versus host disease (GVHD) in the setting of matched related-donor hematopoietic stem cell transplantation (HSCT). This study assessed the inf luences of ATG on the incidences of acute and chronic GVHD and other clinical outcomes in matched related-donor HSCT. METHODS: Sixty-one patients received allogeneic HSCT from human leukocyte antigen-matched, related donors. Patients received busulfan/fludarabine conditioning regimens and standard GVHD prophylaxis with or without additional ATG. RESULTS: There was no significant difference in the cumulative incidences of overall acute GVHD, grade II to IV acute GVHD at day 100, and chronic GVHD during the follow-up period between the ATG and non-ATG groups. Three-year overall survival rates were very similar, but three year disease-free survival of the non-ATG group was higher than that of the ATG group (56.2% for ATG vs. 63.1% for non-ATG, p = 0.597). Relapse rate at 3 years in the ATG group was slightly higher than that of the non-ATG group (37.5% vs. 20%, p = 0.29). Non-relapse mortality rate at 3 years was lower in the ATG group (6.25% vs. 15.6%, p = 0.668). CONCLUSIONS: Although the addition of ATG doesn't guarantee a reduction in the incidences of acute and chronic GVHD, pre-transplantation ATG may result in lower non-relapse mortality in the context of matched related-donor HSCT with a busulfan/fludarabine conditioning regimen. However, caution is needed when using ATG because of a possibility to increase relapse rate.

Airway Responses to Deep Inspiration in Asthma by Different Bronchial Challenge

OBJECTIVE: Deep inspirations (DI) provide physiologic protection against airway narrowing and DI-induced bronchoprotection and bronchodilation are impaired in asthma. METHODS: To evaluate effect of DI on airway narrowing during methacholine challenge, we compared the 2 minutes tidal breathing method and the breath dosimeter method. Methacholine challenge in 12 asthmatics and 10 healthy controls was cross-overly performed by two methods. On first visit, a questionnaire for symptoms, allergy skin test, spirometry, and methacholine challenge was performed. On second visit, spirometry and methacholine challenge using the 25 mg/mL at 5 minutes intervals during the 2 minutes tidal breathing method and the ten-breath dosimeter method were performed on two separate days at same time each day. RESULTS: The decreases in forced expiratory volume in one second (FEV1) and forced vital capacity during the 2 minutes tidal breathing method and dosimeter method in patients with asthmatics were higher than those in normal controls. The decreases in FEV1 and forced vital capacity during the 2 minutes tidal breathing method were higher than during dosimeter method in both asthmatics and controls. CONCLUSION: These observations indicate that the continuous generation method produce more bronchoconstriction than the dosimeter method during methacholine challenge and asthmatics had more bronchoconstriction than controls, suggesting inhibition of DI enhance methacholine induced airway narrowing in asthmatics.