title: Response-guided therapy for steroid-refractory acute GVHD starting with very-low-dose antithymocyte globulin.
abstract: Treatment for steroid-refractory acute graft-versus-host disease (GVHD) has not been established yet. In this article, we report a single-center experience with rabbit antithymocyte globulin (ATG) for the treatment of steroid-refractory acute GVHD. We retrospectively analyzed 11 consecutive patients between December 2009 and December 2013. ATG was given at an initial dose of 1.0 mg/kg for all but one patient with gradual dose escalation while assessing responses. The overall improvement at day 28 was 55% after a median of two treatments (range: 1-5), and a median dose of 3 mg/kg (range: 1.0-11.75 mg/kg) of ATG. Patients with skin (100%, 3/3) and gut (83%, 5/6) responded favorably, whereas the cases with liver involvement showed poor responses (25%, 1/4). The overall survival and transplant-related mortality at 1 year were 55% and 45%, respectively. There were no patients who had developed a post-transplant lymphoproliferative disorder. We suggest that response-guided ATG therapy could be an option for patients with steroid-refractory GVHD, without increasing the incidence of opportunistic infections.
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Nishimoto
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan. Electronic address: hirohisa@msic.med.osaka-cu.ac.jp.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Nakamae
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Koh
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Nakamae
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Asao
authors.initials: A
authors.lastname: Hirose
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nakashima
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nakane
authors.affiliation: Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011817:Rabbits; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000893:Anti-Inflammatory Agents; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011241:Prednisone