title: Impact of thymoglobulin prior to pediatric unrelated umbilical cord blood transplantation on immune reconstitution and clinical outcome.
abstract: In vivo T-cell depletion might contribute to the delayed immune reconstitution observed after unrelated umbilical cord blood transplantation (UCBT). We studied the impact of early, late, and no antithymocyte globulin (ATG) on immune reconstitution and outcome. One hundred twenty seven children receiving UCBT in London or Utrecht were divided into 3 groups: early ATG (days -9 to -5; n = 33), late ATG (days -5 to 0; n = 48), and no ATG (n = 46). The no-ATG group received mycophenolate mofetile + cyclosporin A as graft-versus-host disease (GVHD) prophylaxis, while the ATG groups received cyclosporin A + prednisone. End points studied were survival, immune recovery, infections, and GVHD. The probability of survival was similar in all groups: no ATG, 71% ± 8%; early ATG, 68% ± 9%; and late ATG, 61% ± 7%. CD3(+), CD4(+), and CD4(+)-naive T-cell counts were significantly higher (P < .001) in the no-ATG group at 1, 2, 3, 6, and 12 months post-UCBT. In the no-ATG group, significantly fewer viral reactivations (P = .021) were noted. A higher probability of severe acute GVHD (aGVHD; 31%) was found in the no-ATG group compared with 18% (P = .018) for early-ATG and 5% (P < .001) for late-ATG groups. This was not associated with more chronic GVHD (cGVHD).
authors.affiliation: Pediatric Blood and Bone Marrow Program, University Medical Center Utrecht, The Netherlands;
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Lindemans
authors.forename: Robert
authors.initials: R
authors.lastname: Chiesa
authors.forename: Persis J
authors.initials: PJ
authors.lastname: Amrolia
authors.forename: Kanchan
authors.initials: K
authors.lastname: Rao
authors.forename: Olga
authors.initials: O
authors.lastname: Nikolajeva
authors.forename: Arianne
authors.initials: A
authors.lastname: de Wildt
authors.forename: Corinne E
authors.initials: CE
authors.lastname: Gerhardt
authors.forename: Kimberly C
authors.initials: KC
authors.lastname: Gilmour
authors.forename: Marc
authors.initials: M
authors.lastname: B Bierings
authors.forename: Paul
authors.initials: P
authors.lastname: Veys
authors.forename: Jaap J
authors.initials: JJ
authors.lastname: Boelens
mesh_terms: D000293:Adolescent; D000961:Antilymphocyte Serum / Q000378:metabolism* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005312:Fetal Blood / Q000166:cytology*; D006086:Graft vs Host Disease / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008297:Male; D011336:Probability; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents