Anti-thymocyte globulins for post-transplant graft-versus-host disease prophylaxis-A systematic review and meta-analysis.
Anti-thymocyte globulins for post-transplant graft-versus-host disease prophylaxis-A systematic review and meta-analysis.
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DOI：
10.1016/j.critrevonc.2013.03.009
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发表时间：
2013-10
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通讯作者：
S. Theurich;Hans Fischmann;G. Chakupurakal;A. Shimabukuro-Vornhagen;J. Chemnitz;U. Holtick;A. Rothe;C. Scheid;M. Hallek;N. Skoetz;M. von Bergwelt-Baildon
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作者：
S. Theurich;Hans Fischmann;G. Chakupurakal;A. Shimabukuro-Vornhagen;J. Chemnitz;U. Holtick;A. Rothe;C. Scheid;M. Hallek;N. Skoetz;M. von Bergwelt-Baildon
背景尽管异基因造血干细胞移植（alloSCT）取得了很大进展，但移植物抗宿主病（GvHD）仍然是一个主要问题。对抗GvHD的主要策略是预防，ATG在这一竞技场中发挥着重要作用。ATG对GvHD预防的有效性报告提示我们通过系统评价和荟萃分析来解决这个问题。MethodsSix前瞻性随机对照试验（RCT）比较了添加ATG作为GvHD预防的标准免疫抑制方案。所有的ATG制剂被认为是同质的类型的制剂和剂量必须观察在每个trial.ResultsOur荟萃分析显示，II-IV级GVHD的发病率显着降低在接受ATG的患者。此外，ATG的总生存率，复发或非复发mortality.ConclusionsBased在本系统评价中分析的数据的当前水平，我们不能得出结论的一般建议使用ATG的GvHD预防在alloSCT。在严重GvHD高风险患者中，应单独考虑。然而，由于可分析研究的异质性，未来的研究可能会改变本荟萃分析的汇总数据结果。为了提高目前的数据水平，因此迫切需要对该主题进行进一步的随机研究。
BackgroundDespite 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.MethodsSix 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.ResultsOur 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.ConclusionsBased 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.