Comparison of ATG-thymoglobulin with ATG-Fresenius for Epstein-Barr virus infections and graft-versus-host-disease in pa
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ORIGINAL ARTICLE
Comparison of ATG-thymoglobulin with ATG-Fresenius for Epstein-Barr virus infections and graft-versus-host-disease in patients with hematological malignances after haploidentical hematopoietic stem cell transplantation: a single-center experience Ling Zhou 1 & Zhi-yong Gao 2 & Dao-pei Lu 1 Received: 20 November 2019 / Accepted: 28 March 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Two anti-thymocyte globulin (ATG) forms are used in graft-versus-host disease (GVHD) prophylaxis during haploidentical hematopoietic stem cell transplantations (haplo-HSCTs): ATG-thymoglobulin (ATG-T) and ATG-fresenious (ATG-F). However, comparable dosages for haplo-HSCT remain unclear. We compared and evaluated the effects of ATG-T (7.5 mg/kg) or ATG-F (20 mg/kg) dosages in a relatively homogenous population in haplotype HSCT settings. Patients administered ATG-T 7.5 mg/kg (n = 81) or ATG-F 20 mg/kg (n = 35) as part of GVHD prophylaxis during haplo-HSCT were enrolled. Incidence and severity of GVHD, Epstein–Barr virus (EBV) infection, and immune cell recovery were compared using the Mann-Whitney U rank test and chi-square test. Cumulative incidences of GVHD, EBV infection and its subgroups, and relapse mortality were computed; overall survival (OS) was analyzed using the Kaplan-Meier method, with the log-rank test used for univariate comparison. Risk factors for OS were analyzed by the Cox proportional hazards model. Incidence and cumulative incidence of all grades of acute GVHD and subgroups were comparable in both groups (all p > 0.05); however, cumulative incidence of any grade and limited chronic GVHD was significantly higher in the ATG-T group (p = 0.002, p = 0.007, respectively). Cumulative incidences of EBV infections, EBV-DNAemia, and EBV-related diseases were similar; relapse mortality and OS rates were comparable between both groups (all p > 0.05). ATG-T dosage (7.5 mg/kg) appeared comparable to ATG-F dosage (20 mg/kg) for haplo-HSCT. Currently approved ATG-T and ATG-F doses appear efficient to balance the risk–benefit ratio of GVHD, OS, relapse mortality, and EBV infection in haplo-HSCT. Keywords Anti-human T lymphocyte immunoglobulin . Epstein–Barr virus infection . Graft-versus-host disease . Haploidentical hematopoietic stem cell transplantations . Thymoglobulin . Overall survival
Introduction The number of haploidentical hematopoietic stem cell transplantations (haplo-HSCTs) has increased sharply in the past * Dao-pei Lu [email protected] Ling Zhou [email protected] 1
The Fifth People’s Hospital of Shanghai, Hematology Department, Fudan University, No. 801 Heqing Road, Minhang County, Shanghai 200240, China
2
Hematology Department, Shanghai Dao-Pei Hospital, No. 126 Ruili Road, Minhang County, Shanghai 200240, China
decade. These procedures have benefited from three new methodologies originated from Italy, China, and the USA, and developed further worldwide [1]. Most haplo-HSCT cases in China followed the “GIAC protocol” or modifications of this protocol. The “GIA
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