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Comparative Study
. 2021 Jul;100(7):1837-1847.
doi: 10.1007/s00277-021-04521-z. Epub 2021 May 4.

Impact of anti-thymocyte globulin dose for graft-versus-host disease prophylaxis in allogeneic hematopoietic cell transplantation from matched unrelated donors: a multicenter experience

Sara Butera #  1   2 , Marco Cerrano #  3 , Lucia Brunello  1   4 , Chiara Maria Dellacasa  1 , Danilo Giuseppe Faraci  1   2 , Sara Vassallo  1   2 , Nicola Mordini  5 , Roberto Sorasio  5 , Francesco Zallio  4 , Alessandro Busca  1 , Benedetto Bruno  1   2 , Luisa Giaccone  6   7
Affiliations
Comparative Study

Impact of anti-thymocyte globulin dose for graft-versus-host disease prophylaxis in allogeneic hematopoietic cell transplantation from matched unrelated donors: a multicenter experience

Sara Butera et al. Ann Hematol. 2021 Jul.

Abstract

Despite the widespread use of rabbit anti-thymocyte globulin (ATG) to prevent acute and chronic graft-versus-host disease (aGVHD, cGVHD) after allogeneic hematopoietic cell transplantation (allo-HCT), convincing evidence about an optimal dose is lacking. We retrospectively evaluated the clinical impact of two different ATG doses (5 vs 6-7.5 mg/kg) in 395 adult patients undergoing HSCT from matched unrelated donors (MUD) at 3 Italian centers. Cumulative incidence of aGVHD and moderate-severe cGVHD did not differ in the 2 groups. We observed a trend toward prolonged overall survival (OS) and disease-free survival (DFS) with lower ATG dose (5-year OS and DFS 56.6% vs. 46.3%, p=0.052, and 46.8% vs. 38.6%, p=0.051, respectively) and no differences in relapse incidence and non-relapse mortality. However, a significantly increased infection-related mortality (IRM) was observed in patients who received a higher ATG dose (16.7% vs. 8.8% in the lower ATG group, p=0.019). Besides, graft and relapse-free survival (GRFS) was superior in the lower ATG group (5-year GRFS 43.1% vs. 32.4%, p=0.014). The negative impact of higher ATG dose on IRM and GRFS was confirmed by multivariate analysis. Our results suggest that ATG doses higher than 5 mg/kg are not required for MUD allo-HCT and seem associated with worse outcomes.

Keywords: Anti-thymocyte globulin; GvHD; Hematopoietic stem cell transplantation; Matched unrelated donors.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Cumulative incidence of GVHD. (a) Cumulative incidence of aGVHD grades III to IV and (b) cumulative incidence of moderate to severe cGVHD in patients treated with lower dose (5 mg/kg) and higher dose (6–7.5 mg/kg) of ATG
Fig. 2
Fig. 2
Impact of ATG dose on transplant outcomes. (a) OS, (b) DFS, (c) GRFS, (d) RI, (e) NRM, and (f) IRM in patients treated with lower dose (5 mg/kg) and higher dose (6–7.5 mg/kg) of ATG
Fig. 3
Fig. 3
Subgroup analyses. Impact of ATG dose on (a) OS, (b) GRFS, (c) grade III–IV aGVHD, and (d) moderate/severe cGVHD according to baseline patients’ characteristics
See this image and copyright information in PMC

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