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Bone Marrow Transplant. 2018 Feb;53(2):207-212. doi: 10.1038/bmt.2017.240. Epub 2017 Oct 30.

Role of thymoglobulin in matched sibling allogeneic hematopoietic stem cell transplantation with busulfan and fludarabine conditioning in myeloid malignanicies.

Author information

1
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
2
Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
3
Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
4
Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
5
Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi, South Korea.
6
Department of Hematology, Kyungpook National University Hospital, Daegu, South Korea.
7
Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, South Korea.
8
Department of Internal Medicine, Ulsan University Hospital, Ulsan, South Korea.
9
Department of Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea.
10
Department of Internal Medicine, Busan National University Hospital, Busan, South Korea.
11
Department of Internal Medicine, Busan Paik Hospital, Busan, South Korea.
12
Department of Internal Medicine, Kosin University Gospel Hospital, Busan, South Korea.

Abstract

In vivo T-cell depletion using anti-thymocyte globulin (ATG) is widely used in allogeneic hematopoietic stem cell transplantation (HSCT) for prophylaxis of GvHD. We investigated the influence of thymoglobulin dose (an ATG) on GvHD following matched sibling donor (MSD) HSCT with a busulfan and fludarabine preparative regimen. Medical records of 180 patients who received MSD HSCT with a conditioning regimen of busulfan, fludarabine, and ATG (BuFluATG) were reviewed retrospectively. The median age was 53 years (range 18-68). Initial diagnoses were acute myeloid leukemia (73.3%) and myelodysplastic syndrome (26.7%). Forty-four and 68 patients (24.4 and 37.7%) experienced acute and chronic GvHD of any grade, respectively. High-dose (⩾4.5 mg/kg) ATG was independently associated with decreased risk of acute GvHD (hazard ratio=0.36, 95% confidence interval (CI): 0.15-0.84, P=0.019) compared to low-dose ATG (<4.5 mg/kg). Although ATG dose was associated with the risk of acute GvHD, it was not associated with the risk of chronic GvHD in our study. A higher dose (⩾4.5 mg/kg) of ATG decreases the risk of acute GvHD but had no significant impact on disease-free survival in MSD HSCT patients conditioned with BuFluATG. The optimal dose of ATG should be further investigated in a large prospective study context.

PMID:
29084202
DOI:
10.1038/bmt.2017.240
[Indexed for MEDLINE]

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