Long‐term outcomes of antithymocyte globulin in patients with hematological malignancies undergoing myeloablative allogeneic hematopoietic cell transplantation: a systematic review and meta‐analysis

Abstract

Antithymocyte globulin (ATG) has shown efficacy in preventing acute GVHD (aGVHD) in allogeneic hematopoietic cell transplantation (allo-HCT), but its efficacy in chronic GVHD (cGVHD) and long-term outcomes remains controversial. We conducted a systematic review and meta-analysis to evaluate potential benefit and risk of prophylactic ATG use in myeloablative HCT. We searched Pubmed, EMBASE, Cochrane databases, and included 10 trials (two RCTs and eight retrospective) comparing ATG use vs. control with a total of 1859 patients. The median follow-ups were over two yr. Outcomes assessed included overall cGVHD, extensive cGVHD, overall survival (OS), disease-free survival, relapse, and causes of death. Our results showed ATG significantly decreased overall cGVHD (RR = 0.59; 95% CI: 0.53-0.66, p < 0.00001), extensive cGVHD (RR = 0.34; 95% CI: 0.25-0.47, p < 0.00001). Pooled results also showed ATG use was associated with a marginal increased risk of relapse (RR = 1.28; 95% CI: 1.01-1.63, p = 0.04), and a non-inferior OS (HR = 0.86; 95% CI: 0.74-1.01, p = 0.06). We conclude prophylactic use of ATG exerts a favorable effect in reducing cGVHD without survival impairment in a long term, although a higher relapse rate is a major threat.

Similar outcomes of peripheral blood stem cells vs. bone marrow for human leukocyte antigen‐matched unrelated donor transplantation in adult patients with acute myeloid leukemia using risk‐adapted graft‐versus‐host disease prophylaxis

“…On the other hand, antithymocyte globulin (ATG) has been used as an effective prophylactic agent against GVHD despite concerns of increased risk of relapse or lethal infections . Our previous study, which compared the outcomes of transplants from HLA‐mismatched unrelated donor (URD) with and without low‐dose rabbit ATG (1.25 mg/kg for 2 d), reported a lower incidence of GVHD without increased relapse and infectious complications, which was translated to a lower incidence of non‐relapse mortality (NRM) and survival benefits in the ATG group .…”

Impact of Thymoglobulin by Stem Cell Source (Peripheral Blood Stem Cell or Bone Marrow) After Myeloablative Stem Cell Transplantation From HLA 10/10-Matched Unrelated Donors

“…Better GvHD prevention, even if this does not significantly improve OS, may still be a reasonable approach, which was shown by the results regarding GRFS. Interestingly, based on previous reports, [3][4][5][27][28][29][30] Shin et al 31 applied a risk-adapted GvHD prophylaxis strategy for patients receiving HLA-matched UD transplants, which involved adding low-dose rabbit ATG to the conditioning regimen in transplants using PBSC, but not BM. They report a similar outcome, including a comparable incidence of GvHD between the BM and PBSC groups.…”

Hematopoiesis in Regenerative Medicine

“…Toward this goal, several clinical studies to-date have shown that the depletion of T lymphocytes with antithymocyte/antilymphocyte globulin can be very effective at preventing moderate-to-severe chronic GVHD after transplantation from an unrelated donor [150][151][152][153][154]. Toward this goal, several clinical studies to-date have shown that the depletion of T lymphocytes with antithymocyte/antilymphocyte globulin can be very effective at preventing moderate-to-severe chronic GVHD after transplantation from an unrelated donor [150][151][152][153][154].…”