Impact of thymoglobulin prior to pediatric unrelated umbilical cord blood transplantation on immune reconstitution and clinical outcome
| Autor: | Kanchan Rao, Corinne Gerhardt, Persis Amrolia, Jaap Jan Boelens, Arianne de Wildt, Olga Nikolajeva, KC Gilmour, Paul Veys, Caroline A. Lindemans, Marc Bierings, Robert Chiesa |
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| Rok vydání: | 2014 |
| Předmět: |
Male
endocrine system medicine.medical_specialty Transplantation Conditioning Adolescent Immunology Graft vs Host Disease Cord Blood Stem Cell Transplantation Biochemistry Gastroenterology Disease-Free Survival Young Adult Immune system Risk Factors Prednisone Cyclosporin a Internal medicine medicine Humans Child Antilymphocyte Serum Probability Retrospective Studies Thymoglobulin Umbilical Cord Blood Transplantation business.industry Remission Induction Infant Cell Biology Hematology Fetal Blood medicine.disease Transplantation Treatment Outcome Graft-versus-host disease Child Preschool Female business Immunosuppressive Agents medicine.drug |
| Zdroj: | Blood. 123:126-132 |
| ISSN: | 1528-0020 0006-4971 |
| DOI: | 10.1182/blood-2013-05-502385 |
| Popis: | In vivo T-cell depletion might contribute to the delayed immune reconstitution observed after unrelated umbilical cord blood transplantation (UCBT). We studied the impact of early, late, and no antithymocyte globulin (ATG) on immune reconstitution and outcome. One hundred twenty seven children receiving UCBT in London or Utrecht were divided into 3 groups: early ATG (days -9 to -5; n = 33), late ATG (days -5 to 0; n = 48), and no ATG (n = 46). The no-ATG group received mycophenolate mofetile + cyclosporin A as graft-versus-host disease (GVHD) prophylaxis, while the ATG groups received cyclosporin A + prednisone. End points studied were survival, immune recovery, infections, and GVHD. The probability of survival was similar in all groups: no ATG, 71% ± 8%; early ATG, 68% ± 9%; and late ATG, 61% ± 7%. CD3(+), CD4(+), and CD4(+)-naive T-cell counts were significantly higher (P < .001) in the no-ATG group at 1, 2, 3, 6, and 12 months post-UCBT. In the no-ATG group, significantly fewer viral reactivations (P = .021) were noted. A higher probability of severe acute GVHD (aGVHD; 31%) was found in the no-ATG group compared with 18% (P = .018) for early-ATG and 5% (P < .001) for late-ATG groups. This was not associated with more chronic GVHD (cGVHD). |
| Databáze: | OpenAIRE |
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