Back to Search
Start Over
Prophylactic antithymocyte globulin reduces the risk of chronic graft-versus-host disease in alternative-donor bone marrow transplants.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2002; Vol. 8 (12), pp. 656-61. - Publication Year :
- 2002
-
Abstract
- We studied the impact of preparative regimens with or without antithymocyte globulin (ATG) on chronic GVHD in 160 patients undergoing marrow transplants from unrelated donors (n = 127) or partially mismatched related donors (n = 33). A conditioning regimen that included rabbit ATG, 7.5 to 15 mg/kg (Thymoglobuline; Sangstat, Lyon, France), was given to 102 patients, whereas a conditioning regimen without ATG was given to 58 patients. The median patient age was 34 years for the ATG group and 29 years for the non-ATG group (P = .002); otherwise the 2 groups were matched for disease phase, diagnosis, donor age, interval from diagnosis to transplantation, and number of cells infused at the time of transplant. Median follow-up for surviving patients was 4.5 years (range, l.5-9 years). The conditioning regimen was cyclophosphamide (CY) and total body irradiation (TBI) in 95 patients and CY-thiotepa in 65 patients; the source of stem cells was bone marrow for all patients. Acute GVHD grades II-IV and grades III-IV were reduced in patients receiving ATG compared to patients not receiving ATG (51% versus 74%, P = .004 and 14% versus 28%, P = .03, respectively). There were significantly fewer patients with chronic GVHD in the ATG group than in the non-ATG group at 6 months (14% versus 30%, P = .03), 1 year (7% versus 41%, P = .0001), 2 years (16% versus 36%, P = .02), and 4 years (5% versus 34%, P = .002) and beyond 4 years (0% in 19 patients at risk versus 29% in 24 patients at risk, P = .01). More patients in the ATG group than in the non-ATG group had a performance status (Karnowski score) greater than 90 at last follow-up (93% versus 56%, P = .01) and had discontinued cyclosporin treatment 2 years posttransplant (28% versus 3%, P = .003). Survival rates were comparable in the ATG and non-ATG groups for patients who received TBI (56% versus 59%, P = .7) and those who received thiotepa (33% versus 18%, P = .3). Transplant mortality and relapse rates were also comparable in the 2 groups for these patients. We conclude that pretransplant ATG administration reduces the risk of acute and chronic GVHD, improves quality of life, and increases the likelihood that discontinuation of immunosuppressive therapy will be possible.
- Subjects :
- Adolescent
Adult
Aged
Animals
Female
Follow-Up Studies
Graft vs Host Disease physiopathology
Histocompatibility Testing
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive therapy
Male
Middle Aged
Rabbits
Stem Cell Transplantation
Survival Analysis
Time Factors
Tissue and Organ Harvesting methods
Antilymphocyte Serum therapeutic use
Bone Marrow Transplantation immunology
Graft vs Host Disease prevention & control
Immunosuppressive Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1083-8791
- Volume :
- 8
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 12523577
- Full Text :
- https://doi.org/10.1053/bbmt.2002.v8.abbmt080656