Anti-thymocyte-globulin as part of the preparative regimen prevents graft failure and severe graft versus host disease (GvHD) in allogeneic stem cell transplantation from unrelated donors

• Published in: Annals of hematology 2001-04, Vol.80 (4), p.209-215
• Main Authors: Kröger, N, Zabelina, T, Krüger, W, Renges, H, Stute, N, Dürken, M, Graf von Finkenstein, F, Erttmann, R, Kabisch, H, Schafhausen, P, Jaburg, N, Löliger, C, Zander, A R
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antilymphocyte Serum - therapeutic use; Child; Child, Preschool; Disease-Free Survival; Female; Graft Rejection - prevention & control; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Transplantation; Histocompatibility Testing; Humans; Infant; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - therapy; Leukemia, Myeloid, Acute - therapy; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Recurrence; Reoperation; Transplantation Conditioning; Transplantation, Homologous; Treatment Outcome
• ISSN: 0939-5555; 1432-0584
• DOI: 10.1007/s002770000269

To reduce the incidence of GvHD and the rate of graft failure in unrelated stem cell transplantation, we incorporate anti-thymocyte globulin in the preparative regimen in 98 patients with hematological or inherited storage disease. The median age was 32 years (range: 1-56) and 84 patients underwent transplantation from HLA-A,-B and DR identical donor, while in 14 patients the donor were mismatched either in HLA- A, -B or -DR locus. Only one patient with chronic myelocytic leukemia (CML) and blast crisis had a primary graft failure (1%). Grade II-IV acute GvHD occurred in 37 patients (37%), grade III/IV GvHD developed in 15 patients (15%). Chronic GvHD was observed in 29%, and only 12 patients had extensive GvHD (17%). After a median follow-up of 34 months (range, 9-90), the estimated overall survival at 3 years for all patients is 58% (CI 95%: 48%-68%), and the estimated disease-free survival at 3 years is 49% (CI 95%: 38%-60%). For patients with CML transplanted in first chronic phase or accelerated phase (n=40), the estimated overall survival at 3 years is 70% (CI 95%: 56%-84%), and the estimated disease-free survival at 3 years is 58% (CI 95%: 17%-85%). ATG in unrelated stem cell transplantation reduces the risk of severe acute and chronic GvHD and of graft failure without an obvious increase of severe infection. Further follow-up is mandatory to determine the incidence of late relapse.