Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel
Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel
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DOI：
10.1038/s41409-020-0792-x
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发表时间：
2020-01-22
影响因子：
4.8
通讯作者：
Kroeger, Nicolaus
中科院分区：
文献类型：
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作者：
Bonifazi, Francesca;Rubio, Marie-Therese;Kroeger, Nicolaus
这项合作倡议旨在为使用多克隆抗胸腺细胞球蛋白（ATG）或抗t淋巴细胞球蛋白（ATLG）预防同种异体造血干细胞移植（HSCT）后的移植物抗宿主病（GvHD）提供建议。对截至2018年10月发布的文章进行了全面审查，作为科学证据的来源。14个临床相关的关键问题涉及到适应症、给药和移植后管理，并使用由14名专家组成的专家组采用德尔菲技术提出建议。ATG/ATLG被强烈推荐作为恶性疾病匹配或不匹配的非相关骨髓或外周血同种异体造血干细胞移植前的清髓调节方案的一部分，以预防严重的急性和慢性GvHD。ATG/ATLG也被推荐在hla相同的兄弟姐妹外周HSCT之前进行，证据虽好，但数量较少。在低强度或非清髓调节方案中，ATG/ATLG被认为适合降低急性和慢性GvHD的发病率，但应考虑到较高的复发风险。还提供了有关剂量、应用和预用药的建议，以及移植后的感染预防和疫苗接种。总的来说，这些建议可用于适当和安全地应用多克隆ATG/ATLG来预防同种异体造血干细胞移植后的GvHD。
This collaborative initiative aimed to provide recommendations on the use of polyclonal antithymocyte globulin (ATG) or anti-T lymphocyte globulin (ATLG) for the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). A comprehensive review of articles released up to October, 2018 was performed as a source of scientific evidence. Fourteen clinically relevant key questions to the domains indication, administration, and post-transplant management were developed and recommendations were produced using the Delphi technique involving a Panel of 14 experts. ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD. ATG/ATLG was also recommended prior to HLA-identical sibling peripheral HSCT with good but lesser bulk of evidence. In reduced intensity or nonmyeloablative conditioning regimens, ATG/ATLG was deemed appropriate to reduce the incidence of acute and chronic GvHD, but a higher risk of relapse should be taken into account. Recommendations regarding dose, application, and premedication were also provided as well as post-transplant infectious prophylaxis and vaccination. Overall, these recommendations can be used for a proper and safe application of polyclonal ATG/ATLG to prevent GvHD after allogeneic HSCT.