title: Intensification of GVHD prophylaxis with low-dose ATG-F before allogeneic PBSC transplantation from HLA-identical siblings in adult patients with hematological malignancies: results from a retrospective analysis.
abstract: Several studies have shown that chronic GVHD (cGVHD) is more frequent in patients receiving transplants from PBSC than in those receiving BM. In the setting of PBSC-unrelated transplants, the addition of anti-T-cell globulin (ATG) has shown a significant decrease in incidence/severity of cGVHD, without an increase in relapses or infections. However, no prospective data are yet available in the sibling setting. We retrospectively analyzed the effects of intensification of standard GVHD prophylaxis (CsA+MTX) by the addition of low-dose ATG in 245 patients receiving a transplant from HLA-identical sibling. From 1996 to 2001, patients received PBSC as the preferred source (group 2), and then ATG was added before transplant (group 3) because of a high cGVHD rate. Patients receiving BM in the same time period were analyzed as a control group (group 1). The incidence of grade III-IV acute GVHD and cGVHD was not significantly different in the three groups, but extensive cGVHD was highest in group 2 (38%) compared with group 3 (21%) or group 1 (28%; P=0.03). OS, TRM and time to relapse/progression were similar in the three groups. Our analysis shows that adding ATG to PBSC sibling allogeneic transplants can lower cGVHD, without an increase of relapse. Further prospective studies are needed to confirm these findings.
authors.affiliation: Institute of Hematology and Medical Oncology, L and A Seràgnoli, St Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, Bologna, Italy. francesca.bonifazi@unibo.it
authors.forename: F
authors.initials: F
authors.lastname: Bonifazi
authors.forename: G
authors.initials: G
authors.lastname: Bandini
authors.forename: M
authors.initials: M
authors.lastname: Arpinati
authors.forename: G
authors.initials: G
authors.lastname: Tolomelli
authors.forename: M
authors.initials: M
authors.lastname: Stanzani
authors.forename: M R
authors.initials: MR
authors.lastname: Motta
authors.forename: S
authors.initials: S
authors.lastname: Rizzi
authors.forename: V
authors.initials: V
authors.lastname: Giudice
authors.forename: E
authors.initials: E
authors.lastname: Dan
authors.forename: E
authors.initials: E
authors.lastname: Massari
authors.forename: P
authors.initials: P
authors.lastname: Tazzari
authors.forename: A
authors.initials: A
authors.lastname: Bontadini
authors.forename: P
authors.initials: P
authors.lastname: Pagliaro
authors.forename: M
authors.initials: M
authors.lastname: Baccarani
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000628:therapy*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D035781:Siblings; D014184:Transplantation, Homologous
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents