Korean J Intern Med.
2020 Mar;35(2):429-437. 10.3904/kjim.2018.317.
Clinical impact of anti-thymocyte globulin on survival and graft-versus-host disease in patients undergoing human leukocyte antigen mismatched allogeneic stem cell transplantation
- Affiliations
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- 1Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
- 2Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- 3Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 4Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 5Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
- 6Department of Hematology, Kyungpook National University Hospital, Daegu, Korea
- 7Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- 8Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
- KMID: 2502029
- DOI: http://doi.org/10.3904/kjim.2018.317
Abstract
- Background/Aims
Rabbit anti-thymocyte globulin (ATG) is usually incorporated in hematopoietic stem cell transplantation (HSCT) to reduce the incidence of graft-versus-host disease (GVHD). This study aimed to find optimal ATG doses in patients undergoing human leukocyte antigen (HLA)-mismatched allogeneic HSCT.
Methods
We retrospectively collected medical records from 352 consecutive patients with acute myeloid leukemia (n = 214), acute lymphoblastic leukemia (n = 62), or myelodysplastic syndrome (n = 76) in eight centers of Korea between 2005 and 2015. All patients received busulfan-based conditioning without total body irradiation (TBI) and received stem cells from HLA-mismatched donors.
Results
In the current study, 5-year overall survival rates of patients receiving low to medium doses of ATG (2.5 to 7.5 mg/kg) were higher than those receiving other doses of ATG (hazard ratio [HR], 0.528; 95% confidence interval [CI], 0.311 to 0.897; p = 0.018). The incidence rates of extensive chronic GVHD (ecGVHD) after administration of low to medium doses of ATG were lower than those after other doses of ATG (HR, 0.447; 95% CI, 0.224 ton 0.889; p = 0.022).
Conclusions
The low to medium doses of ATG may be associated with improving survival outcomes and reducing incidence of ecGVHD without enhancing the chances of relapse in patients with acute leukemia or myelodysplastic syndrome undergoing non-TBI-based HLA-mismatched allogeneic HSCT.
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