title: Effective prevention of GVHD using in vivo T-cell depletion with anti-lymphocyte globulin in HLA-identical or -mismatched sibling peripheral blood stem cell transplantation.
abstract: To investigate the impact of anti-lymphocyte globulin (ATG-Fresenius) as part of the HLA-sibling transplantation, we evaluated 238 patients (median age 48 years) with different diagnoses (AML, ALL, CML and lymphoproliferative disorders). A total of 79 patients received ATG and 159 patients did not. In the ATG group, there were more HLA-mismatched donors (6% vs 1%, p=0.02), bad risk patients (70% vs 55%, P=0.04), reduced intensity conditioning (RIC) regimens (65% vs 34%, P=<0.001) and older patients (median age 51 vs 48 years, P=0.002). The median time to leukocyte engraftment was significantly faster in the non-ATG group (13 vs 15 days, P < 0.001). EBV reactivation was more often seen in the ATG group (9% vs 2%, P=0.05). Cumulative incidence of acute and chronic GVHD was less observed in the ATG group (27% vs 40%, P=0.004, and 33% vs 54%, P=0.002). The cumulative incidence rates of non-relapse mortality and of relapse at 5 years were 20 and 34%, respectively, for ATG and 34 and 29%, respectively, for non-ATG (P=0.06 and P=0.3). ATG can prevent GVHD without an obvious risk of relapse but should be confirmed in a randomized study.
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Wolschke
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Zabelina
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Ayuk
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Alchalby
authors.affiliation: Department of Medical Statistics, University Medical Center, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Berger
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Klyuchnikov
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: U-M
authors.initials: UM
authors.lastname: Pein
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schumacher
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Amtsfeld
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Adjallé
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Wortmann
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Lellek
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Randenborgh
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Zander
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center, Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Kröger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002648:Child; D002986:Clinical Trials as Topic; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D006680:HLA Antigens / Q000276:immunology; D006402:Hematologic Diseases / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007962:Leukocytes / Q000166:cytology; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D035781:Siblings; D013601:T-Lymphocytes / Q000166:cytology*; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens
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