title: Low incidences of acute and chronic graft-versus-host disease after unrelated bone marrow transplantation with low-dose anti-T lymphocyte globulin.
abstract: Anti-T lymphocyte globulin (ATG) is commonly used as prophylaxis for graft-versus-host disease (GVHD), especially in patients who are at high risk of GVHD. The appropriate dosage of ATG in Japan has not yet been assessed. We therefore conducted a nationwide survey of patients who received ATG-Fresenius as GVHD prophylaxis for unrelated bone marrow transplantation (uBMT). A total of 86 patients were identified (median age 31 years, range 1-68). The median total dose of ATG was 10 mg/kg. The cumulative incidence of neutrophil engraftment was 90 %. The probability of 2-year overall survival (OS) was 67 %. The cumulative incidence of 2-year non-relapse mortality was 25 %. The incidences of grade II-IV and grade III-IV acute GVHD were 20 and 8 %, respectively. The incidences of chronic and extensive chronic GVHD were 19 and 8 %, respectively. In adult patients, there was a reduction of acute GVHD with high-dose ATG (>10 mg/kg), which did not reach statistical significance. In conclusion, the addition of low-dose ATG to GVHD prophylaxis in Japanese patients who received uBMT resulted in decreased incidences of both acute and chronic GVHD without compromising OS. The effects of low-dose ATG should be assessed in a prospective clinical trial.
authors.affiliation: Department of Hematology/Oncology, Wakayama Medical University Hospital, Wakayama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Hatanaka
authors.forename: Shigeo
authors.initials: S
authors.lastname: Fuji
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ikegame
authors.forename: Ruri
authors.initials: R
authors.lastname: Kato
authors.forename: Atsushi
authors.initials: A
authors.lastname: Wake
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hidaka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Ito
authors.forename: Masami
authors.initials: M
authors.lastname: Inoue
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nagatoshi
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Takami
authors.forename: Naokuni
authors.initials: N
authors.lastname: Uike
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Yabe
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000517:prevention & control*; D006306:Health Surveys; D006402:Hematologic Diseases / Q000401:mortality / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007223:Infant; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013601:T-Lymphocytes / Q000276:immunology*; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents