title: Treatment of steroid-resistant acute graft-versus-host disease with anti-thymocyte globulin.
abstract: Acute graft-versus-host disease (aGVHD) is a major cause of mortality after allogeneic stem cell transplantation. Although initial treatment with corticosteroids is effective in the majority of patients, 30--60% develop steroid resistance. Anti-thymocyte globulin (ATG) is commonly used as first-line therapy for steroid resistant (SR) aGVHD. However, data on its efficacy are limited. At two institutions we reviewed the results of treatment with ATG of 58 patients with SR aGVHD. Initial manifestations of aGVHD were treated with 2 mg/kg/day of methylprednisolone (MP). Equine ATG was administered as first-line therapy for SR aGVHD, a median of 9 days (range, 3 to 39) after initiation of MP. At the time of initiation of ATG, IBMTR severity indices B, C and D were observed in 6%, 40% and 54% of patients, respectively. Improvement was observed in 30% of patients treated with ATG. Skin disease was more likely to improve with ATG (79%), while progression of gut and liver aGVHD was observed in 40% and 66% of patients, respectively. Despite initial improvement, 52 patients (90%) died a median of 40 days after ATG therapy from progressive aGVHD and/or infection (74%), ARDS (15%), or relapse (11%). Only six patients (10%), three of whom had aGVHD limited to the skin at the time ATG was administered, are long-term survivors. We conclude that initial improvement of SR aGVHD occurs with ATG in a minority of patients, and very few patients become long-term survivors. Furthermore, this treatment is associated with a high rate of major complications.
authors: Washington University School of Medicine, Department of Medicine, Division of Bone Marrow Transplantation and Stem Cell Biology, St Louis, MO 63110-1093, USA.
authors: H
authors: H
authors: Khoury
authors: A
authors: A
authors: Kashyap
authors: D R
authors: DR
authors: Adkins
authors: R A
authors: RA
authors: Brown
authors: G
authors: G
authors: Miller
authors: R
authors: R
authors: Vij
authors: P
authors: P
authors: Westervelt
authors: K
authors: K
authors: Trinkaus
authors: L T
authors: LT
authors: Goodnough
authors: R J
authors: RJ
authors: Hayashi
authors: P
authors: P
authors: Parker
authors: S J
authors: SJ
authors: Forman
authors: J F
authors: JF
authors: DiPersio
mesh_terms: D000206:Actuarial Analysis; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013256:Steroids; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects / Q000401:mortality
chemical_list: D000961:Antilymphocyte Serum; D013256:Steroids