Unrelated Donor Transplant Recipients Given Thymoglobuline Have Superior GRFS When Compared to Matched Related Donor Recipients Undergoing Transplantation without ATG
| Autor: | Christopher Arthur, Sam Milliken, Ian Bilmon, David Gottlieb, Matthew Greenwood, Shyam Panicker, Jad Othman, David D.F. Ma, Keith Fay, Leonie Wilcox, John Kwan, Emily Blyth, William Stevenson, John Moore, Nada Hamad, Lindsay Dunlop, Stephen Larsen, Ian Kerridge, Adam Bryant, Kenneth P. Micklethwaite, Anne-Marie Watson, Abir Bhattacharyya, Barbara Withers, Steven Tran, John Gibson, Christian E Bryant |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Myeloid Transplantation Conditioning medicine.medical_treatment Graft vs Host Disease Hematopoietic stem cell transplantation Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Transplantation Homologous Prospective Studies Antilymphocyte Serum Retrospective Studies Transplantation business.industry Incidence (epidemiology) Hematopoietic Stem Cell Transplantation Hematology medicine.disease Confidence interval Transplant Recipients Anti-thymocyte globulin surgical procedures operative Graft-versus-host disease medicine.anatomical_structure 030220 oncology & carcinogenesis Stem cell Neoplasm Recurrence Local business Unrelated Donors 030215 immunology |
| Zdroj: | Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 26(10) |
| ISSN: | 1523-6536 |
| Popis: | Recipients of allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated donors (URDs) and mismatched related donors (MMRDs) typically have a higher incidence of acute and chronic graft-versus-host disease (GVHD) compared with matched related donors (MRDs). Anti-T-cell globulins (ATGs) are often used to reduce GVHD in these recipients. We report the outcomes of 211 adult peripheral blood stem cell transplant recipients with myeloid malignancies who received a standardized transplant protocol, in which ATG (Thymoglobuline 4.5 mg/kg) was administered to recipients of URD and MMRD (n = 147) but not MRD (n = 64) transplant. For all patients, incidence of acute GVHD grades 2 to 4 was 21.4%, and chronic GVHD was 35.0%. Two-year overall survival was 63.2% (95% confidence interval, 55.8% to 71.5%), relapse-free survival was 55.3% (47.4% to 64.6%), and GVHD-free, relapse-free survival (GRFS) was 30.7% (23.2% to 40.8%). There were no differences between recipients of MRDs and other donors in relapse, nonrelapse mortality, and overall and relapse-free survival. However, compared with MRD, recipients from URDs and MMRDs had reduced moderate to severe chronic GVHD (10.4% versus 30.1%, P= .002), less chronic GVHD requiring systemic therapy (19.4% versus 38.9%, P = .006), and superior 2-year GRFS (35.5% versus 20.0%, P = .003). In this retrospective review of nonrandomized transplant groups, outcomes of HSCT performed using an URD with ATG during conditioning were superior to transplant from an MRD without ATG. The addition of Thymoglobuline to conditioning in HSCT from MRD should be further examined in prospective trials. |
| Databáze: | OpenAIRE |
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