title: The effect of different ATG preparations on immune recovery after allogeneic hematopoietic stem cell transplantation for severe aplastic anemia.
abstract: Anti-thymocyte globulin (ATG) is widely used in the conditioning regimen before allogeneic stem cell transplantation for aplastic anemia. However, there are several different preparations of ATG and little is known about the difference of their effects on transplantation outcome. Therefore, in this study, we retrospectively compared the effect of two different rabbit ATG preparations [Thymoglobulin (ATG-G) and ATG-Fresenius (ATG-F)] on immune recovery and cytomegalovirus infection after transplantation. The conditioning regimen was a combination of fludarabine, cyclophosphamide, and ATG. Low dose total body irradiation was added in alternative donor transplantation. Four patients received ATG-F at 5 mg/kg/day from day -7 to day -3, whereas ATG-G was given at 2.5 mg/kg/day from day -5 to day -2 in three patients. There was no graft rejection and no grade II-IV acute graft-versus-host disease. All three patients in the ATG-G group developed positive cytomegalovirus antigenemia including two with high-grade antigenemia, whereas two of the four patients in the ATG-F group were persistently negative. Immunological evaluation on day 60 revealed that both CD4+ and CD8+ T-cell recoveries were delayed in the ATG-G group. These findings suggested that ATG-G has a stronger immunosuppressive activity than the ATG-F with a dose ratio of 1:2.5.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Kiriko
authors.initials: K
authors.lastname: Terasako
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Miki
authors.initials: M
authors.lastname: Sato
authors.forename: Shun-ichi
authors.initials: S
authors.lastname: Kimura
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Shinya
authors.initials: S
authors.lastname: Okuda
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.forename: Yukie
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Rie
authors.initials: R
authors.lastname: Yamazaki
authors.forename: Kumi
authors.initials: K
authors.lastname: Oshima
authors.forename: Aki
authors.initials: A
authors.lastname: Tanihara
authors.forename: Takakazu
authors.initials: T
authors.lastname: Higuchi
authors.forename: Junji
authors.initials: J
authors.lastname: Nishida
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000276:immunology / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000737:chemistry / Q000627:therapeutic use*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007155:Immunologic Factors / Q000737:chemistry / Q000627:therapeutic use*; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000961:Antilymphocyte Serum; D007155:Immunologic Factors