Association between pretransplant Thymoglobulin and reduced non-relapse mortality rate after marrow transplantation from unrelated donors
Association between pretransplant Thymoglobulin and reduced non-relapse mortality rate after marrow transplantation from unrelated donors
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DOI：
10.1038/sj.bmt.1703374
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发表时间：
2002-03-01
影响因子：
4.8
通讯作者：
Anasetti, C
中科院分区：
文献类型：
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作者：
Remberger, M;Storer, B;Anasetti, C
一项匹配队列研究旨在测试人 T 细胞（胸腺球蛋白）特异性多克隆兔抗血清的功效，该血清在充满 T 细胞的无关供体骨髓移植前第 1-5 天（2 毫克/公斤/天）体内施用。 Huddinge 医院为 52 名白血病患者注射了胸腺球蛋白。同一时期在西雅图选择了诊断、疾病分期、年龄相匹配并接受类似治疗方案（除了省略胸腺球蛋白）的对照患者（n = 104）。所有患者均接受环磷酰胺和 TBI 调理。在研究组中，所有患者均接受 10 Gy 单剂量 TBI，而对照组则接受 12-14.4 Gy 分次 TBI。 GVHD 预防药物为环孢素和甲氨蝶呤。研究组患者接受 I 级急性 GVHD 治疗，对照组患者接受 II 级急性 GVHD 治疗。根据患者和捐献者年龄、CMV 血清学、HLA 匹配、捐献者性别和骨髓细胞剂量调整多变量分析。研究患者的非复发死亡率较低（风险比 = 0.30，95% CI 0.12-0.75，P 值 = 0.005）。研究队列的 5 年累积非复发死亡率为 19%，对照组为 35%。研究患者的总体死亡率也较低（风险比 0.51，95% CI 0.27-0.97，P 值 = 0.03）。复发风险没有显着差异（P = 0.63）。这表明调节过程中的胸腺球蛋白可能会降低无关供体骨髓移植后的非复发死亡率。
A matched cohort study was designed to test the efficacy of polyclonal rabbit antiserum specific for human T cells (Thymoglobulin), administered in vivo on days 1-5 (2 mg/kg/day) before T cell-replete unrelated donor marrow transplantation. Thymoglobulin was given to 52 leukemic patients at Huddinge Hospital. Control patients matched for diagnosis, disease stage, age and treated with a similar regimen, apart from the omission of Thymoglobulin, were selected in Seattle during the same period (n = 104). All received conditioning with cyclophosphamide and TBI. In the study group all patients received 10 Gy single dose TBI, while the controls were given 12-14.4 Gy fractionated TBI. GVHD prophylaxis was cyclosporine and methotrexate. Patients were treated for grade I acute GVHD in the study group, and for grade II GVHD in the control group. Multivariable analyses were adjusted for patient and donor age and CMV serology, HLA matching, donor gender and marrow cell dose. Non-relapse mortality was lower in the study patients (hazard ratio = 0.30, 95% CI 0.12-0.75, P value = 0.005). The 5-year cumulative incidence of non-relapse mortality was 19% in the study cohort, and 35% in the control cohort. Overall mortality was also lower in study patients (hazard ratio 0.51, 95% CI 0.27-0.97, P value = 0.03). No significant difference in the risk of relapse was seen (P = 0.63). This suggests that Thymoglobulin during conditioning may reduce non-relapse mortality after unrelated donor marrow transplantation.