title: Low-dose antithymocyte globulin enhanced the efficacy of tacrolimus and mycophenolate for GVHD prophylaxis in recipients of unrelated SCT.
abstract: We performed a retrospective analysis of the outcome of 197 consecutive unrelated donor transplant recipients who received GVHD prophylaxis either TM regimen (tacrolimus and mycophenolate) (121 patients) or TM/ATG-G regimen (TM with low-dose antithymocyte globulin (ATG) of 4.5 mg/kg, ATG-G, Genzyme) (76 patients). Cumulative incidences of grade II-IV acute GVHD for the TM and TM/ATG-G cohorts were 49% and 61% (P=0.11) and grade III-IV acute GVHD for the TM and TM/ATG-G cohorts were 27% and 14% (P=0.02), respectively. There was no difference in the incidence of relapse or disease progression between TM and TM/ATG-G-16% and 23% (P=0.64). TM/ATG-G cohort had lower incidence of non-relapse mortality (NRM; 37% vs 20%, P=0.01), chronic GVHD (56% vs 43%, P<0.001) and more favorable global chronic GVHD severity (P<0.001). Univariate analyses showed improved OS and PFS of patients who received TM/ATG-G. Multivariate analysis confirmed TM/ATG-G had a favorable influence on OS (P=0.05) but not on PFS (P=0.07). We concluded that low-dose ATG of 4.5 mg/kg given in conjunction with TM improved GVHD prophylaxis without increased risk of relapse. Lower NRM, lower incidence and severity of chronic GVHD could potentially improve survival.
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: V
authors.initials: V
authors.lastname: Ratanatharathorn
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: A
authors.initials: A
authors.lastname: Deol
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: L
authors.initials: L
authors.lastname: Ayash
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: S
authors.initials: S
authors.lastname: Cronin
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: D
authors.initials: D
authors.lastname: Bhutani
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Lum
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Abidi
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ventimiglia
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: K
authors.initials: K
authors.lastname: Mellert
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, Department of Oncology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Uberti
mesh_terms: D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D012307:Risk Factors; D033581:Stem Cell Transplantation; D016559:Tacrolimus / Q000008:administration & dosage*; D061349:Unrelated Donors
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus