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Clinical Trial
. 2020 Jan;99(1):167-179.
doi: 10.1007/s00277-019-03884-8. Epub 2019 Dec 11.

Reduced risk of chronic GVHD by low-dose rATG in adult matched sibling donor peripheral blood stem cell transplantation for hematologic malignancies

Liping Dou  1 , Cheng Hou  1 , Chao Ma  1 , Fei Li  1 , Xiaoning Gao  1 , Wenrong Huang  1 , Shuhong Wang  1 , Chunji Gao  1 , Li Yu  1 , Daihong Liu  2
Affiliations
Clinical Trial

Reduced risk of chronic GVHD by low-dose rATG in adult matched sibling donor peripheral blood stem cell transplantation for hematologic malignancies

Liping Dou et al. Ann Hematol. 2020 Jan.

Abstract

The optimal rabbit anti-thymocyte globulin (rATG) graft-versus-host disease (GVHD) prophylaxis regimen in matched sibling donor peripheral blood stem cell transplantation (MSD-PBSCT) remains to be elucidated. In this prospective study, we used low-dose rATG for GVHD prophylaxis in patients or donors aged ≥ 40 years with hematological malignancies receiving MSD-PBSCT. rATG was administered to 40 patients at an intravenous dose of 5 mg/kg divided over day 5 and day 4 before graft infusion. No graft failure occurred. Median times to leukocyte engraftment and platelet engraftment were 11.0 days and 13.9 days. The cumulative incidence of grades 2-4 and grades 3-4 acute GVHD at day +100 was 30.0% and 2.6%. The 2-year cumulative incidence of extensive chronic GVHD and severe chronic GVHD was 11.4% and 14.7%. 93.5% (29/31) of patients had discontinued immunosuppressive medication within 3 years after transplantation. The 2-year cumulative incidence of transplant-related mortality (TRM) and relapse was 14.0% and 22.6%. The cumulative incidence of cytomegalovirus reactivation, Epstein-Barr virus reactivation, and fungal infection was 22.3%, 12.9%, and 12.5%. Kaplan-Meier estimates for overall survival, disease-free survival, and GVHD-free and relapse-free survival 3 years after transplantation were 68.9%, 68.9%, and 54.0%. rATG for GVHD prophylaxis is tolerable and efficacious at a 5 mg/kg total dose administered over 2 days (days -5 to -4) in patients receiving allogeneic MSD-PBSCT.

Keywords: ATG; Graft-versus-host disease; Peripheral blood; Relapse; Stem cell transplantation.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Cumulative incidence of aGVHD, cGVHD, TRM, relapse, OS, and DFS after MSD-PBSCT with low-dose rATG in combination with cyclosporine, mycophenolate, and short-term methotrexate for GVHD prophylaxis. GVHD, graft-versus-host disease; TRM, treatment-related mortality; OS, overall survival; DFS, disease-free survival
Fig. 2
Fig. 2
Cumulative incidence of aGVHD and cGVHD after MSD-PBSCT with low-dose rATG or no rATG in combination with cyclosporine, mycophenolate, and short-term methotrexate for GVHD prophylaxis. GVHD, graft-versus-host disease
Fig. 3
Fig. 3
Cumulative incidence of TRM, relapse, OS, DFS, and GRFS after MSD-PBSCT with low-dose rATG or no rATG in combination with cyclosporine, mycophenolate, and short-term methotrexate for GVHD prophylaxis. NRM, means treatment-related mortality; OS, overall survival; DFS, disease-free survival; GRFS, GVHD-free relapse-free survival; GVHD, graft-versus-host disease
Fig. 4
Fig. 4
Lymphocyte counts, stratified into CD3+, CD4+, CD8+, and CD56/CD16+ subpopulations, at days +30, +60, +90, +180, +240, and +360 after MSD-PBSCT with low-dose rATG in combination with cyclosporine, mycophenolate, and short-term methotrexate for GVHD prophylaxis
See this image and copyright information in PMC

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