title: Comparison of conditioning regimens with or without antithymocyte globulin for unrelated cord blood transplantation in children with high-risk or advanced hematological malignancies.
abstract: The role and potential efficacy of antithymocyte globulin (ATG) in patients receiving cord blood transplantation (CBT) remain controversial. We retrospectively evaluated the effect of ATG on patient outcomes in 207 children with high-risk or advanced hematological malignancies at 8 child blood disease centers in China. The cumulative incidence of platelet recovery on day 100 was significantly lower in the ATG cohort compared with the non-ATG cohort (77.3% versus 89.8%) (P = .046). There was no significant difference in the incidence of grade II to IV acute and chronic graft-versus-host disease (GVHD), and transplantation-related mortality (TRM) between the 2 groups (P = .76, P = .57, and P = .46, respectively). The incidence of CMV infection was significantly higher among the ATG group compared with that among the non-ATG group (P = .003). The 5-year cumulative incidence of relapse was significantly higher in the ATG cohort (30.7% versus 15.4%) (P = .009). Overall survival in the non-ATG group was slightly higher than that of the ATG cohort (64.1% versus 52.1%, P = .093) and leukemia-free survival in the non-ATG cohort was significantly higher than in the ATG cohort (56.6% versus 37.7%, P = .015). Our study demonstrated that, for high-risk or advanced childhood hematological malignancies receiving unrelated CBT, patients who received conditioning that omitted ATG had a faster platelet recovery, a comparable GVHD and TRM, a significantly lower relapse risk, and an improved long-term survival compared with those patients who received ATG in the conditioning.
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: Changcheng
authors.initials: C
authors.lastname: Zheng
authors.affiliation: Department of Pediatrics, Navy General Hospital of People's Liberation Army, Beijing, China. Electronic address: luanzuo@aliyun.com.
authors.forename: Zuo
authors.initials: Z
authors.lastname: Luan
authors.affiliation: Department of Pediatrics, Sun Yet-sen Memorial Hospital, Sun Yet-sen University, Guangzhou, China.
authors.forename: Jianpei
authors.initials: J
authors.lastname: Fang
authors.affiliation: Department of Hematology and Oncology, Guangzhou Women and Children's Medical Center, Guangzhou, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Hematology and Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Chi Kong
authors.initials: CK
authors.lastname: Li
authors.affiliation: Department of Hematology and Oncology, The Children's Hospital of Soochow University, Suzhou, China.
authors.forename: Shaoyan
authors.initials: S
authors.lastname: Hu
authors.affiliation: Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu, China.
authors.forename: Yiping
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
authors.forename: Zimin
authors.initials: Z
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D064591:Allografts; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*
chemical_list: D000961:Antilymphocyte Serum; D007155:Immunologic Factors
keywords: Antithymocyte globulin; Children; Cord blood transplantation; Hematological malignancies