Impact of low-dose rabbit anti-thymocyte globulin in unrelated hematopoietic stem cell transplantation
Impact of low-dose rabbit anti-thymocyte globulin in unrelated hematopoietic stem cell transplantation
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DOI：
10.1007/s12185-016-1947-9
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发表时间：
2016-04-01
影响因子：
2.1
通讯作者：
Fukuda, Takahiro
中科院分区：
文献类型：
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作者：
Kuriyama, Kodai;Fuji, Shigeo;Fukuda, Takahiro
我们回顾性评估了219例首次接受非相关造血干细胞移植（uHSCT）的患者（ATG-T组，n = 30；无ATG-T组，n = 189）给予低剂量兔抗胸腺细胞球蛋白（胸腺球蛋白：ATG-T）的结果。ATG-T的中位总剂量为1.5 mg/kg。急性GVHD II-IV级（42比38%，P = 0.87）和III-IV级（5比7%，P = 0.52）的累积发病率无显著差异。在从至少有一个HLA等位基因不匹配的供体接受uHSCT的患者中，ATG-T组的广泛慢性GVHD累积发病率显著低于无ATG-T组（13% vs. 44%, P = 0.02）。ATG-T组无患者出现慢性肺功能障碍。ATG-T组1年无gvhd /无复发生存率（GRFS）为61%，无ATG-T组为35% （P = 0.02）。ATG-T组患者停药时间明显早于无ATG-T组（P < 0.01）。使用低剂量ATG-T不会增加严重传染病的发生率。在接受uHSCT的患者中使用低剂量ATG-T与优越的GRFS相关，反映出在不影响总生存期的情况下，严重/持续性GVHD的发生率降低。
We retrospectively evaluated the outcome of administering low-dose rabbit anti-thymocyte globulin (thymoglobulin: ATG-T) to 219 patients (ATG-T group, n = 30; no-ATG-T group, n = 189) who received an initial unrelated hematopoietic stem cell transplantation (uHSCT). The median total dose of ATG-T was 1.5 mg/kg. There was no significant difference in the cumulative incidences of grade II-IV (42 vs. 38 %, P = 0.87) and grade III-IV (5 vs. 7 %, P = 0.52) acute GVHD. In patients who received uHSCT from a donor with at least one HLA allele mismatch, the cumulative incidence of extensive chronic GVHD was significantly lower in the ATG-T group than that in the no-ATG-T group (13 vs. 44 %, P = 0.02). No patient in the ATG-T group developed chronic lung dysfunction. The probabilities of 1-year, GVHD-free/relapsefree survival (GRFS) were 61 % in the ATG-T group and 35 % in the no-ATG-T group (P = 0.02). Patients in the ATG-T group discontinued immunosuppressive drugs significantly earlier than those in the no-ATG-T group (P < 0.01). The use of low-dose ATG-T did not increase the incidence of severe infectious disease. The use of low-dose ATG-T in patients who received uHSCT was associated with a superior GRFS, reflecting the reduced incidence of severe/persistent GVHD without compromising overall survival.