Reduced-intensity conditioning regimen with low-dose ATG-F for unrelated bone marrow transplant is associated with lower
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ORIGINAL ARTICLE
Reduced-intensity conditioning regimen with low-dose ATG-F for unrelated bone marrow transplant is associated with lower non-relapse mortality than a regimen with low-dose TBI: a single-center retrospective analysis of 103 cases Shigeo Fuji • Niina Ueno • Nobuhiro Hiramoto • Yoshitaka Asakura • Kimikazu Yakushijin • Yutaro Kamiyama • Saiko Kurosawa • Sung-Won Kim Yuji Heike • Takuya Yamashita • Takahiro Fukuda
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Received: 31 March 2013 / Revised: 17 September 2013 / Accepted: 17 September 2013 / Published online: 4 October 2013 Ó The Japanese Society of Hematology 2013
Abstract Although anti-T lymphocyte globulin-Fresenius (ATG-F) is commonly used as prophylaxis for graftversus-host disease (GVHD), the appropriate dosage of ATG-F in the setting of a reduced-intensity conditioning (RIC) regimen has not been determined. In the present study, we retrospectively analyzed the clinical outcomes of 103 patients after unrelated bone marrow transplant (uBMT) with RIC regimens. RIC regimens consisted of purine analogue plus busulfan with low-dose TBI or ATGF (5–10 mg/kg in total). Median age was 57 years (range 20–68). The incidence of grade II–IV acute GVHD and chronic GVHD with ATG-F was significantly lower than that with TBI 2 Gy (15 vs. 61 %, P \ 0.05; 33 vs. 57 %, P \ 0.05). The incidence of 2-year NRM with ATG-F was significantly lower than that with TBI 2 Gy (6 vs. 28 %, P \ 0.05). There was no statistically significant difference in the cumulative incidence of 2-year relapse between the ATG-F and TBI 2 Gy groups (37 vs. 20 %, P = 0.13). In conclusion, the addition of low-dose ATG-F to GVHD prophylaxis in patients who received uBMT resulted in decreased incidence of acute and chronic GVHD, which led to a significantly reduced risk of NRM without compromising overall survival. The beneficial effect of lowdose ATG-F should be assessed in a prospective clinical trial.
S. Fuji N. Ueno N. Hiramoto Y. Asakura K. Yakushijin Y. Kamiyama S. Kurosawa S.-W. Kim Y. Heike T. Yamashita T. Fukuda (&) Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan e-mail: [email protected]
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Keywords ATG Unrelated bone marrow transplant GVHD
Introduction After Slavin and co-workers [1–3] introduced a reducedintensity conditioning (RIC) regimen using fludarabine (Flu)/busulfan (Bu), similar regimens have been widely used worldwide. Bornha¨user et al. [2] reported that a RIC regimen using Flu/Bu/Anti-T lymphocyte globulin (ATG) was associated with a high risk of graft failure (GF). The incidence of GF was higher in patients who received bone marrow (BM, 31 %) as compared to unmanipulated peripheral blood stem cells (PBSC, 10 %), although this difference was not statistically significant [2]. In contrast, Nagler et al. [3] reported that a RIC regimen using Flu/Bu/ ATG followed by an unrelated BMT (uBMT) was not associated with GF. In general, PBSC is preferred in the setting of RIC, due to the risk of GF [4]. However, in Ja
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