The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Does anti-thymocyte globulin have a place in busulfan/fludarabine conditioning for matched related donor hematopoietic stem cell transplantation?

  • Ji, Young Sok (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Min Sung (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Min, Chang Wook (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Park, Seong Kyu (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Se Hyung (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Yun, Jina (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Hyun Jung (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Kim, Kyoung Ha (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital) ;
  • Kim, Chan Kyu (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Kyu-Taek (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital) ;
  • Won, Jong-Ho (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital) ;
  • Hong, Dae Sik (Division of Hemato-Oncology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital)
  • Received : 2015.07.22
  • Accepted : 2015.09.13
  • Published : 2016.07.01
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Abstract

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 inf luences 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.

Keywords

References

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