The prophylactic application of low-dose rabbit antithymocyte globulin in matched siblings HSCT with high-risk factors for graft-versus-host disease

IF 1.6 4区医学 Q4 IMMUNOLOGY

Transplant immunology Pub Date : 2024-09-20 DOI:10.1016/j.trim.2024.102131

Lei Deng, Xiaolin Yu, Xiaocheng Song, Rui Guan, Wenjun Li, Ximing Liu, Yan Shao, Yixi Hou, Yuerong Zhao, Jing Wang, Yue Liu, Qianqian Xiao, Bo Xin, Fang Zhou

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Abstract

Relapse and graft-versus-host disease (GVHD) are currently the predominant causes of mortality post allogeneic hematopoietic stem cell transplantation (allo-HSCT). The contentious use of antithymocyte globulin (ATG) for preventing GVHD in matched sibling HSCT scenarios has been a topic of significant debate. A retrospective analysis was conducted on matched sibling HSCT cases with high-risk factors for GVHD in our center from January 2018 to June 2023. Our assessment revealed that the group administered with ATG exhibited a 30 % incidence of acute GVHD (aGVHD), in contrast to 81.8 % in the non-ATG cohort (P = 0.037) among matched sibling HSCT cases with high GVHD risk factors. Furthermore, chronic GVHD (cGVHD) occurred in 20 % of the ATG group and 72.7 % of the non-ATG group (P = 0.03). Notably, the administration of ATG did not significantly impact disease relapse (p = 0.149), infection rates (p = 0.64), granulocyte recovery time (p = 0.15), platelet recovery time (p = 0.12), overall survival (p = 0.889), or disease-free survival time (p = 0.787). The use of rabbit antithymocyte globulin (r-ATG) at a 5 mg/kg dosage demonstrated a notable reduction in aGVHD and cGVHD incidences within sibling matched HSCT cases with high-risk factors for GVHD, without increasing rates of disease recurrence or infections. These findings highlight the potential benefit of using low-dose r-ATG in high-risk of GVHD sibling matched allogeneic HSCTs, although further validation with a larger cohort is necessary.

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在具有移植物抗宿主病高风险因素的配对同胞造血干细胞移植中预防性应用小剂量兔抗胸腺细胞球蛋白。

复发和移植物抗宿主疾病（GVHD）是目前异基因造血干细胞移植（allo-HSCT）后死亡的主要原因。在配对同胞造血干细胞移植中使用抗胸腺细胞球蛋白（ATG）预防GVHD一直是备受争议的话题。我们对本中心2018年1月至2023年6月期间具有GVHD高危因素的配对同胞造血干细胞移植病例进行了回顾性分析。我们的评估结果显示，在具有高GVHD风险因素的配对同胞造血干细胞移植病例中，使用ATG的组群急性GVHD（aGVHD）发生率为30%，而非ATG组群的急性GVHD（aGVHD）发生率为81.8%（P = 0.037）。此外，20%的ATG组和72.7%的非ATG组发生了慢性GVHD（cGVHD）（P = 0.03）。值得注意的是，ATG的应用对疾病复发（P = 0.149）、感染率（P = 0.64）、粒细胞恢复时间（P = 0.15）、血小板恢复时间（P = 0.12）、总生存期（P = 0.889）或无病生存期（P = 0.787）没有明显影响。使用 5 毫克/千克剂量的兔抗胸腺细胞球蛋白（r-ATG）明显降低了具有 GVHD 高危因素的同胞匹配造血干细胞移植病例的 aGVHD 和 cGVHD 发生率，而不会增加疾病复发率或感染率。这些研究结果突显了在GVHD高危同胞匹配异基因造血干细胞移植中使用小剂量r-ATG的潜在益处，不过还需要通过更大的队列进行进一步验证。

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来源期刊

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.