Antithymocyte globulin for the prevention of graft-versus-host disease after unrelated hematopoietic stem cell transplantation for acute myeloid leukemia: results from the multicenter German cooperative study group

Basara, Nadežda; Baurmann, Herrad; Kolbe, Karin; Yaman, Ali; Labopin, Myriam; Burchardt, Alexander; Huber, Christoph; Fauser, AA; Schwerdtfeger, Rainer

doi:10.1038/sj.bmt.1704957

Cited by 92 publications

(65 citation statements)

References 38 publications

(32 reference statements)

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“…8,36 As all three patients, who did not receive ATG during the preparative regimen, developed chronic GVHD and there is no difference to the earlier FLAMSA studies, the low incidence of chronic GVHD might be partly explained by the use of ATG. 40 In general, toxicities associated with the combination treatment with sirolimus and MMF were moderate. However, in conditions requiring effective wound healing, sirolimus should be used with caution because it inhibits PDGF and basic fibroblast growth factor, 41 thus possibly interfering with wound healing.…”

Section: Discussionmentioning

confidence: 99%

Calcineurin inhibitor-free GVHD prophylaxis with sirolimus, mycophenolate mofetil and ATG in Allo-SCT for leukemia patients with high relapse risk: an observational cohort study

Schleuning

Judith

Jedlickova

et al. 2008

Bone Marrow Transplant

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Section: Discussionmentioning

confidence: 99%

Calcineurin inhibitor-free GVHD prophylaxis with sirolimus, mycophenolate mofetil and ATG in Allo-SCT for leukemia patients with high relapse risk: an observational cohort study

Schleuning

Judith

Jedlickova

et al. 2008

Bone Marrow Transplant

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“…Several studies have shown that ATG reduces the incidence of GVHD, both in related and unrelated donor transplants, and that this effect is dose dependent. 4,13,[33][34][35][36][37][38][39] Using conventional conditioning, we previously reported that a very low dose of thymoglobulin (4 mg/kg) increases the incidence of both severe acute GVHD and TRM compared to higher doses. 13 High doses resulted in a low incidence of GVHD but no survival benefit due to an increased risk for infections.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for acute graft-versus-host disease grades II–IV after reduced intensity conditioning allogeneic stem cell transplantation with unrelated donors—a single centre study

Remberger

Mattsson

Hassan

et al. 2007

Bone Marrow Transplant

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We analysed factors associated with moderate to severe acute GVHD in 111 patients treated with fludarabinbased reduced intensity conditioning (RIC) and allogeneic haematopoietic stem cell transplantation (HSCT). Most patients had a haematological malignancy. Donors were 97 HLA-A, -B and -DRb1 identical unrelated and 14 HLA-A, -B or -DRb1 allele mismatched unrelated donors. In the univariate analysis, we found ten factors associated with acute GVHD. These were diagnosis (P ¼ 0.06), GVHD prophylaxis with combinations other than CsA þ MTX (P ¼ 0.006), graft nucleated (Po0.001) and CD34 (Po0.001) cell-dose, bidirectional ABO mismatch (P ¼ 0.001), conditioning (P ¼ 0.002), hospital vs home-care (P ¼ 0.06), ATG dose (Po0.001), donor herpes virus serology (P ¼ 0.07) and an immunized female donor to male recipient (P ¼ 0.05). In the multivariate analysis, three factors remained significant: a high CD34 cell dose (Po0.001), low dose (4 mg/kg) ATG (Po0.001), and an immunized female donor to male recipient (Po0.01). Patients receiving a CD34 cell dose X17.0 Â 10 6 per kg had a higher incidence of GVHD, 53.7%, compared to 22.3% in patients receiving a lower dose (P ¼ 0.002). In patients without any of these risk factors (n ¼ 70), the incidence of acute GVHD was 14.1%, while it was 38.0 and 85.0% in patients with one (n ¼ 29) or two (n ¼ 10) risk factors (Po0.001). We concluded that risk factors for acute GVHD using RIC are similar as using myeloablative conditioning.

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“…Chronic GvHD was more frequent in the ATG Sangstat patients (40 vs 20%) and there was a trend for improved survival in the ATG Sangstat group, due to reduced leukemia relapse. 24 The second study, in patients with chronic myeloid leukemia, showed again more chronic GvHD in patients receiving ATG Sangstat (24%, n ¼ 46 vs 0%, n ¼ 14), but the trend for improved survival was in the ATG Fresenius patients. 27 Different ATG brands are different.…”

Section: Are Different Brands Of Atg Any Different?mentioning

confidence: 99%

“…24,27 The first study looked at patients with acute myeloid leukemia grafted from UDs in Germany: 49 received ATG SangstatGenzyme and 46 received ATG Fresenius. Chronic GvHD was more frequent in the ATG Sangstat patients (40 vs 20%) and there was a trend for improved survival in the ATG Sangstat group, due to reduced leukemia relapse.…”

Section: Are Different Brands Of Atg Any Different?mentioning

confidence: 99%

“…[18][19][20][21][22][23][24][25][26][27][28][29][30] One of these 23 23 Recently, the German cooperative group studied 155 patients with acute myeloid leukemia (AML) undergoing an allogeneic UD transplant: 87 received ATG as part of the conditioning regimen, whereas 68 did not. Grade III-IV acute GvHD was seen in 12% of the ATG patients vs 22% of the non-ATG patients (P ¼ 0.04) 24 (Table 1).…”

Section: Comparative Nonrandomized Studiesmentioning

confidence: 99%

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Antilymphocyte/thymocyte globulin for graft versus host disease prophylaxis: efficacy and side effects

Bacigalupo

2004

Bone Marrow Transplant

109

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Summary:Antilymphocyte/thymocyte globulins (ALGs/ATGs) have now been used for over 30 years in the setting of hemopoietic stem cell transplants (HSCT), with the aim of preventing graft-versus-host disease (GvHD). This is true especially for transplants from alternative donors. In this review, we will be discussing available published and unpublished data on the advantages and disadvantages of using ALG/ATG before or after an allogeneic HSCT. These studies show that ALG/ATG significantly reduce the incidence and severity of acute and chronic GvHD. Unfortunately, they also show that immune deficiency is a more prolonged and infectious complication more frequent in patients receiving ALG/ATG, suggesting the importance of aggressive monitoring of viral and fungal infections. In particular, the emerging problem of Epstein-Barr virus (EBV) infections and EBV-related lymphoproliferative disorders will be discussed, together with the use of pre-emptive therapy with rituximab. I personally believe ALG/ATG has an important role in allogeneic HSCT, especially today with the increasing use of peripheral blood transplants and the consequent high risk of chronic GvHD. ALG/ATG should be used with caution, and the negative consequences must be understood and possibly prevented. Bone Marrow Transplantation (2005) 35, 225-231.

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Antithymocyte globulin for the prevention of graft-versus-host disease after unrelated hematopoietic stem cell transplantation for acute myeloid leukemia: results from the multicenter German cooperative study group

Cited by 92 publications

References 38 publications

Calcineurin inhibitor-free GVHD prophylaxis with sirolimus, mycophenolate mofetil and ATG in Allo-SCT for leukemia patients with high relapse risk: an observational cohort study

Calcineurin inhibitor-free GVHD prophylaxis with sirolimus, mycophenolate mofetil and ATG in Allo-SCT for leukemia patients with high relapse risk: an observational cohort study

Risk factors for acute graft-versus-host disease grades II–IV after reduced intensity conditioning allogeneic stem cell transplantation with unrelated donors—a single centre study

Antilymphocyte/thymocyte globulin for graft versus host disease prophylaxis: efficacy and side effects

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