[Anti-CD25 monoclonal antibody with antithymocytic globulin for steroid-resistant severe acute graft-versus-host disease after unrelated donor hematopoietic stem cell transplantation].
OBJECTIVE
To study the effect of anti-CD25 monoclonal antibody (mAb) combined with antithymocytic globulin (ATG) in the treatment of severe steroid-resistant acute graft-versus-host disease (aGVHD) after unrelated donor hematopoietic stem cell transplantation (UD-HSCT).


METHODS
Ten leukemic patients who developed severe steroid-resistant aGVHD during UD-HSCT received a standard dose of anti-CD25 mAb and a medium or low dose of ATG. The effect on aGVHD control, patients' survival, infection and relapse after the therapy were analyzed.


RESULTS
Eight of the 10 patients had complete remission and 2 had partial remission after the combined therapy. In the 8 patients with complete remission, 2 developed third degree aGVHD 3-3.5 months after the transplantation, and were managed with a second combined therapy to successfully achieve complete remission. In the total of 12 combined treatments, the median time of therapeutic effect was 5 days (3-10 days); the median complete relief time was 12 days (8-30 days) in the 10 cases. Among the 8 patients who survived for more than 3 months, 7 were diagnosed to have chronic GVHD including 4 with extensive chronic GVHD. No relapse of leukemia was found in these patients. Five patients survived the 2-year-long follow-up after the transplantation with survival time over 2 years; of the 5 patients who died within 2 years after the transplantation, 1 survived for more than one year, and 4 for less than 6 months. Two patients died from invasive fungal infection, two from aGVHD and one from cGVHD-induced multiple organ failure.


CONCLUSIONS
Anti-CD25 mAb combined with ATG has good therapeutic effect on steroid-resistant sever aGVHD and may help achieve high complete remission rate and long-term survival in leukemic patients after UD-HSCT.
Ye
Chang-xiong
CX
Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Sun
Jing
J
Liu
Qi-fa
QF
Qu
Hong
H
Xu
Dan
D
Zhang
Yu
Y
Meng
Fan-yi
FY
D000208:Acute Disease; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D053645:Interleukin-2 Receptor alpha Subunit / Q000276:immunology*; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D055815:Young Adult
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D053645:Interleukin-2 Receptor alpha Subunit; D011241:Prednisone