Low-dose antithymocyte globulin inhibits chronic graft-versus-host disease in peripheral blood stem cell transplantation from unrelated donors

Souichi Shiratori, Junichi Sugita, Shigeo Fuji, Jun Aoki, Masashi Sawa, Yukiyasu Ozawa, Daigo Hashimoto, Ken ichi Matsuoka, Kazunori Imada, Noriko Doki, Takashi Ashida, Yasunori Ueda, Masatsugu Tanaka, Yasushi Sawayama, Tatsuo Ichinohe, Seitaro Terakura, Satoko Morishima, Yoshiko Atsuta, Takahiro Fukuda, Takanori Teshima

Research output: Contribution to journalArticlepeer-review

Abstract

Antithymocyte globulin (ATG) has been shown to reduce chronic graft-versus-host disease (GVHD) particularly in allogeneic peripheral blood stem cell transplantation (PBSCT) from unrelated donors; however, anti-GVHD effects of lower doses of ATG remains to be elucidated. We conducted a nationwide retrospective study to compare the outcomes of unrelated PBSCT with or without rabbit ATG (thymoglobulin) in 287 patients. A median ATG dose was 2.0 mg/kg. The primary endpoint, the cumulative incidence of moderate–severe chronic GVHD at 2 years was 22.1% in the ATG group, which was significantly less than that in the non-ATG group (36.3%, P = 0.025). The ATG group had a higher incidence of immunosuppressant discontinuation, GVHD-free, relapse-free survival, and moderate–severe chronic GVHD-free, relapse-free survival at 2 years compared to the non-ATG group. The incidences of grade III–IV aGVHD and moderate–severe chronic GVHD were significantly higher in patients with high absolute lymphocyte count (ALC) before the administration of ATG, whereas relapse rate was significantly higher in patients with low ALC before ATG. In conclusion, low-dose ATG effectively suppresses chronic GVHD in unrelated PBSCT, and ALC before ATG may be a potential predictor for GVHD and relapse.

Original languageEnglish
Pages (from-to)2231-2240
Number of pages10
JournalBone Marrow Transplantation
Volume56
Issue number9
DOIs
Publication statusPublished - Sep 2021

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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