ATG prevents severe acute graft-versus-host disease in mismatched unrelated donor hematopoietic cell transplantation.
ATG prevents severe acute graft-versus-host disease in mismatched unrelated donor hematopoietic cell transplantation.
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DOI：
10.1016/j.bbmt.2010.12.705
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发表时间：
2011-08
期刊：
影响因子：
--
通讯作者：
Anasetti C
中科院分区：
文献类型：
--
作者：
Pidala J;Tomblyn M;Nishihori T;Ayala E;Field T;Fernandez H;Perez L;Locke F;Alsina M;Ochoa JL;Perkins J;Tate C;Shapiro J;Conwell M;Bookout R;Anasetti C
Severe acute graft-versus-host disease (aGVHD) remains a major source of morbidity and mortality following mismatched unrelated donor hematopoietic cell transplantation (HCT). Through a retrospective analysis, we investigated the efficacy of GVHD prophylaxis with rabbit anti-thymocyte globulin (ATG) 7.5 mg/kg (1 mg/kg given on day −3, then 3.25 mg/kg/day on days −2 and −1 before stem cell infusion) followed by standard tacrolimus plus methotrexate in a consecutive series of 45 HLA partially matched unrelated donor HCT recipients. The cumulative incidence of grade III–IV aGVHD was 11% by 100 days (95% confidence interval [CI] 5%–25%). Moderate to severe chronic GVHD (per NIH consensus criteria) was 19% (95% CI 10%–36%) at 1 year, and 28% (95% CI 16%–48%) at 2 years. With a median follow-up time for surviving patients of 12 months (range: 5–39 months), overall survival was 55% (95% CI 39%–71%) at 1 year, and 45% (95% CI 27%–63%) at 2 years. Nonrelapse mortality was 11% (95% CI 5%–25%) by 100 days post-HCT, 26% (95% CI 16%–44%) by 1 year, and 30% (95% CI 18%–50%) by 2 years. The cumulative incidence of primary disease relapse was 23% (95% CI 13%–41%) at 1 year, and 33% (95% CI 20%–56%) by 2 years after HCT. Cytomegalovirus (CMV) infection or reactivation varied according to recipient and donor CMV serostatus. Epstein-Barr Virus (EBV) reactivation occurred in 54% (95% CI 40%–71%) of patients. Preemptive rituximab therapy was administered for EBV reactivation, however, posttransplant lymphoproliferative disorder was diagnosed in 5 (11%) cases, and was fatal in 1. A regimen of ATG 7.5 mg/kg total ending on day −1 effectively decreased the occurrence of grade III–IV aGVHD and severe chronic GVHD.
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