Anti-thymocyte globulin for conditioning in matched unrelated donor hematopoietic cell transplantation provides comparable outcomes to matched related donor recipients

Abstract

Rabbit anti-thymocyte globulin (ATG) is used as prophylaxis against GVHD following allogeneic hematopoietic cell transplantation (HCT). At our institution, ATG is exclusively used in the conditioning of matched unrelated donor (URD) transplant recipients. A total of 50 URD HCT recipients who received ATG (ATG group) were retrospectively compared with 48 matched related donor (MRD) HCT recipients who did not receive ATG (no ATG group). There were no significant differences between the groups in rates of day 100 mortality, acute GVHD or relapse. Chronic GVHD incidence was significantly lower in the ATG group (P = 0.007). At a median follow-up of 36 months in the entire cohort, 50% patients are alive in the ATG group and 63% of the patients are alive in the no ATG group (P = 0.13). We conclude that the administration of ATG to patients undergoing URD HCT preserves the anti-leukemia benefit of the transplant, while reducing the risk of developing GVHD, resulting in OS rates that are comparable to MRD HCT recipients.

Influence of two different doses of antithymocyte globulin in patients with standard-risk disease following haploidentical transplantation: a randomized trial

“…In a recent report, a subset analysis of the URD HSCT recipients demonstrated a significantly higher (P ¼ 0.005) mortality rate in the 10 mg/kg ATG dose recipients (18/26, 69%) than in the 7.5 mg/kg dose recipients (7/17, 29%), and this large difference stemmed from a higher day-100 mortality mostly attributable to non-relapse and non-GVHD mortality in the highdose ATG group (10/26, 39%) than in the low-dose group (1/24, Two different doses of ATG in haploidentical HSCT Y Wang et al 4%; P ¼ 0.003). 16 In the haploidentical setting, ATG in the conditioning provided a major contribution to controlling alloreactivity. 17 ATG has a key role in our unique haploidentical preparative regimen, and our recent reports validated its use in haploidentical HSCT both for patients with advanced-stage leukemia 18 and for patients with severe aplastic anemia.…”

“…2,4,[14][15][16] A total dose of 4.5-5 mg/kg and 7.5 mg/kg ATG has been recommended in the ISD and the URD settings, respectively. In a recent report, a subset analysis of the URD HSCT recipients demonstrated a significantly higher (P ¼ 0.005) mortality rate in the 10 mg/kg ATG dose recipients (18/26, 69%) than in the 7.5 mg/kg dose recipients (7/17, 29%), and this large difference stemmed from a higher day-100 mortality mostly attributable to non-relapse and non-GVHD mortality in the highdose ATG group (10/26, 39%) than in the low-dose group (1/24, Two different doses of ATG in haploidentical HSCT Y Wang et al 4%; P ¼ 0.003).…”

Mouse Flk-1+Sca-1- Mesenchymal Stem Cells

“…It has been demonstrated that human, nonhuman primate, and mouse bMSCs can inhibit T-cell proliferation induced either in a MLR or by nonspecific mitogens (12). This suppression occurs regardless of the MHC of bMSCs, and the stimulator and responder lymphocytes (13,14). The immunoregulatory effect of bMSCs appears to be, at least in part, mediated by the production of cytokines such as TGFA-1 and hepatocyte growth factors and is independent of the induction of apoptosis (15).…”

Older recipient age is paradoxically associated with a lower incidence of chronic GVHD in Thymoglobulin recipients: a retrospective study exploring risk factors for GVHD in allogeneic transplantation with Thymoglobulin GVHD prophylaxis

“…32 In studies comparing related donor and UD alloHSCT, it appears that in the presence of TG prophylaxis, donor relatedness is no longer a risk factor for developing cGVHD. 33,34 We hypothesised that other previously identified risk factors may also lose their utility for predicting aGVHD and cGVHD risk when TG is used, thus raising the need for new predictors of GVHD. We analysed the cumulative incidence of aGVHD and cGVHD in a large cohort of alloHSCT recipients treated with a uniform dose of TG.…”