Does anti-thymocyte globulin have a place in busulfan/fludarabine conditioning for matched related donor hematopoietic stem cell transplantation?

作者：Ji Young Sok; Lee Min Sung; Min Chang Wook; Park Seong Kyu^*; Kim Se Hyung; Yun Jina; Kim Hyun Jung; Kim Kyoung Ha; Kim Chan Kyu; Lee Kyu Taek; Won Jong Ho; Hong Dae Sik

来源：Korean Journal of Internal Medicine, 2016, 31(4): 750-761.

DOI：10.3904/kjim.2015.234

• Antithymocyte globulin
• Graft vs host disease
• Related donor
• Hematopoietic stem cell transplantation
• Fludarabine

Background/Aims: There is controversy about the prophylactic effect of anti-thymocyte globulin (ATG) on graft versus host disease (GVHD) in the setting of matched related-donor hematopoietic stem cell transplantation (HSCT). This study assessed the influences of ATG on the incidences of acute and chronic GVHD and other clinical outcomes in matched related-donor HSCT.
Methods: Sixty-one patients received allogeneic HSCT from human leukocyte antigen-matched, related donors. Patients received busulfan/fludarabine conditioning regimens and standard GVHD prophylaxis with or without additional ATG.
Results: There was no significant difference in the cumulative incidences of overall acute GVHD, grade II to IV acute GVHD at day 100, and chronic GVHD during the follow-up period between the ATG and non-ATG groups. Three-year overall survival rates were very similar, but three year disease-free survival of the non-ATG group was higher than that of the ATG group (56.2% for ATG vs. 63.1% for non-ATG, p = 0.597). Relapse rate at 3 years in the ATG group was slightly higher than that of the non-ATG group (37.5% vs. 20%, p = 0.29). Non-relapse mortality rate at 3 years was lower in the ATG group (6.25% vs. 15.6%, p = 0.668).
Conclusions: Although the addition of ATG doesn't guarantee a reduction in the incidences of acute and chronic GVHD, pre-transplantation ATG may result in lower non-relapse mortality in the context of matched related-donor HSCT with a busulfan/fludarabine conditioning regimen. However, caution is needed when using ATG because of a possibility to increase relapse rate.

• 出版日期2016-7