1. Impact of anti-thymocyte globulin dose for graft-versus-host disease prophylaxis in allogeneic hematopoietic cell transplantation from matched unrelated donors: a multicenter experience.
- Author
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Butera S, Cerrano M, Brunello L, Dellacasa CM, Faraci DG, Vassallo S, Mordini N, Sorasio R, Zallio F, Busca A, Bruno B, and Giaccone L
- Subjects
- Adult, Allografts, Antilymphocyte Serum administration & dosage, Antilymphocyte Serum adverse effects, Cyclosporine therapeutic use, Disease-Free Survival, Dose-Response Relationship, Immunologic, Female, Graft vs Host Disease epidemiology, Graft vs Host Disease etiology, Hematologic Neoplasms therapy, Histocompatibility, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Incidence, Infections etiology, Infections mortality, Kaplan-Meier Estimate, Male, Methotrexate therapeutic use, Middle Aged, Mycophenolic Acid therapeutic use, Proportional Hazards Models, Recurrence, Retrospective Studies, T-Lymphocytes immunology, Unrelated Donors, Antilymphocyte Serum therapeutic use, Graft vs Host Disease prevention & control, Hematopoietic Stem Cell Transplantation adverse effects
- Abstract
Despite the widespread use of rabbit anti-thymocyte globulin (ATG) to prevent acute and chronic graft-versus-host disease (aGVHD, cGVHD) after allogeneic hematopoietic cell transplantation (allo-HCT), convincing evidence about an optimal dose is lacking. We retrospectively evaluated the clinical impact of two different ATG doses (5 vs 6-7.5 mg/kg) in 395 adult patients undergoing HSCT from matched unrelated donors (MUD) at 3 Italian centers. Cumulative incidence of aGVHD and moderate-severe cGVHD did not differ in the 2 groups. We observed a trend toward prolonged overall survival (OS) and disease-free survival (DFS) with lower ATG dose (5-year OS and DFS 56.6% vs. 46.3%, p=0.052, and 46.8% vs. 38.6%, p=0.051, respectively) and no differences in relapse incidence and non-relapse mortality. However, a significantly increased infection-related mortality (IRM) was observed in patients who received a higher ATG dose (16.7% vs. 8.8% in the lower ATG group, p=0.019). Besides, graft and relapse-free survival (GRFS) was superior in the lower ATG group (5-year GRFS 43.1% vs. 32.4%, p=0.014). The negative impact of higher ATG dose on IRM and GRFS was confirmed by multivariate analysis. Our results suggest that ATG doses higher than 5 mg/kg are not required for MUD allo-HCT and seem associated with worse outcomes.
- Published
- 2021
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