The effect of different ATG preparations on immune recovery after allogeneic hematopoietic stem cell transplantation for severe aplastic anemia
The effect of different ATG preparations on immune recovery after allogeneic hematopoietic stem cell transplantation for severe aplastic anemia
复制标题
DOI：
10.1179/102453309x12583347113852
复制
发表时间：
2010-06-01
期刊：
影响因子：
1.9
通讯作者：
Kanda, Yoshinobu
中科院分区：
文献类型：
--
作者：
Terasako, Kiriko;Sato, Ken;Kanda, Yoshinobu
抗胸腺细胞球蛋白（ATG）广泛用于再生障碍性贫血同种异体干细胞移植前的预处理方案。然而，ATG 有几种不同的制剂，但人们对它们对移植结果影响的差异知之甚少。因此，本研究回顾性比较了两种不同的兔ATG制剂[胸腺球蛋白（ATG-G）和ATG-费森尤斯（ATG-F）]对移植后免疫恢复和巨细胞病毒感染的影响。预处理方案是氟达拉滨、环磷酰胺和 ATG 的组合。替代供体移植中增加了低剂量全身照射。四名患者从第-7天到第-3天接受5mg/kg/天的ATG-F，而三名患者从第-5天到第-2天接受2.5mg/kg/天的ATG-G。无移植物排斥反应，无II-IV级急性移植物抗宿主病。 ATG-G 组的所有 3 名患者均出现巨细胞病毒抗原血症阳性，其中 2 名患者出现高级别抗原血症，而 ATG-F 组的 4 名患者中有 2 名患者的巨细胞病毒抗原血症持续呈阴性。第 60 天的免疫学评估显示，ATG-G 组的 CD4+ 和 CD8+ T 细胞恢复均延迟。这些结果表明，在剂量比为1:2.5时，ATG-G比ATG-F具有更强的免疫抑制活性。
Anti-thymocyte globulin (ATG) is widely used in the conditioning regimen before allogeneic stem cell transplantation for aplastic anemia. However, there are several different preparations of ATG and little is known about the difference of their effects on transplantation outcome. Therefore, in this study, we retrospectively compared the effect of two different rabbit ATG preparations [Thymoglobulin (ATG-G) and ATG-Fresenius (ATG-F)] on immune recovery and cytomegalovirus infection after transplantation. The conditioning regimen was a combination of fludarabine, cyclophosphamide, and ATG. Low dose total body irradiation was added in alternative donor transplantation. Four patients received ATG-F at 5 mg/kg/day from day -7 to day -3, whereas ATG-G was given at 2.5 mg/kg/day from day -5 to day -2 in three patients. There was no graft rejection and no grade II-IV acute graft-versus-host disease. All three patients in the ATG-G group developed positive cytomegalovirus antigenemia including two with high-grade antigenemia, whereas two of the four patients in the ATG-F group were persistently negative. Immunological evaluation on day 60 revealed that both CD4+ and CD8+ T-cell recoveries were delayed in the ATG-G group. These findings suggested that ATG-G has a stronger immunosuppressive activity than the ATG-F with a dose ratio of 1 : 2.5.