title: Total and active rabbit antithymocyte globulin (rATG;Thymoglobulin) pharmacokinetics in pediatric patients undergoing unrelated donor bone marrow transplantation.
abstract: Rabbit antithymocyte globulin (rATG; Thymoglobulin) is currently used to prevent or treat graft-versus-host disease (GVHD) during hematopoietic stem cell transplantation (HSCT). The dose and schedule of rATG as part of the preparative regimen for unrelated donor (URD) bone marrow transplantation (BMT) have not been optimized in pediatric patients. We conducted a prospective study of 13 pediatric patients with hematologic malignancies undergoing URD BMT at St. Jude Children's Research Hospital from October 2003 to March 2005, to determine the pharmacokinetics and toxicities of active and total rATG. The conditioning regimen comprised total body irradiation (TBI), thiotepa, and cyclophosphamide (Cy); cyclosporine (CsA) and methotrexate (MTX) were administered as GVHD prophylaxis. Patients received a total dose of 10 mg/kg rATG, and serial blood samples were assayed for total rATG by enzyme linked immunosorbent assay (ELISA) and active rATG by florescein activated cell sorting (FACS). We found that our weight-based dosing regimen for rATG was effective and well tolerated by patients. The half-lives of total and active rATG were comparable to those from previous studies, and despite high doses our patients had low maximum concentrations of active and total rATG. There were no occurrences of grade iii-iv GVHD even in patients having low peak rATG levels, and the overall incidence of grade II GVHD was only 15%. None of the patients had serious infections following transplantation. These data support the use of a 10 mg/kg dose of rATG in children with hematologic malignancies because it can be administered without increasing the risk of graft rejection, or serious infection in pediatric patients with a low rate of GVHD. These conclusions may not apply to patients with nonmalignant disorders.
authors.affiliation: Department of Pharmaceutical Services, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA. sandy.call@stjude.org
authors.forename: Sandra K
authors.initials: SK
authors.lastname: Call
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Kasow
authors.forename: Raymond
authors.initials: R
authors.lastname: Barfield
authors.forename: Renee
authors.initials: R
authors.lastname: Madden
authors.forename: Wing
authors.initials: W
authors.lastname: Leung
authors.forename: Edwin
authors.initials: E
authors.lastname: Horwitz
authors.forename: Paul
authors.initials: P
authors.lastname: Woodard
authors.forename: John C
authors.initials: JC
authors.lastname: Panetta
authors.forename: Sharyn
authors.initials: S
authors.lastname: Baker
authors.forename: Rupert
authors.initials: R
authors.lastname: Handgretinger
authors.forename: John
authors.initials: J
authors.lastname: Rodman
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
mesh_terms: D000293:Adolescent; D000818:Animals; D000961:Antilymphocyte Serum / Q000008:administration & dosage* / Q000097:blood / Q000633:toxicity; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006086:Graft vs Host Disease / Q000517:prevention & control; D006207:Half-Life; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D015994:Incidence; D011446:Prospective Studies; D011817:Rabbits; D014019:Tissue Donors; D019172:Transplantation Conditioning / Q000379:methods
chemical_list: D000961:Antilymphocyte Serum