title: Reduced platelet transfusions and earlier platelet engraftment using alemtuzumab-based conditioning regimen in allogeneic stem cell transplantation.
abstract: OBJECTIVE
  In patients undergoing allogeneic stem cell transplantation, conditioning regimens containing alemtuzumab instead of anti-thymocyte globulin (ATG) may result in an earlier platelet engraftment and a reduced number of platelet transfusions.
  
  
  METHODS
  We performed a retrospective, single-center, case-control study analyzing time to engraftment and transfusion needs using alemtuzumab in comparison with ATG as part of conditioning protocol.
  
  
  RESULTS
  Median values for time to platelet engraftment, number of transfused platelet concentrates and number of transfused red cell concentrates were 12 versus 19.5 days (p < 0.001), 2 versus 14 (p < 0.001) and 6 versus 14.5 (p = 0.003) in the alemtuzumab and ATG group. Time to leukocyte engraftment did not differ with median 15 days in both groups. Patients in the ATG group showed a significant higher decrease in platelet count during conditioning (68 vs. 29 %, p = 0.001), leading to significant lower median platelet counts at the day of stem cell infusion (38 vs. 95.5 Gpt/l, p = 0.008), and higher values for median C-reactive protein after first antibody infusion (69.0 vs. 43.6 mg/l, p = 0.001) compared with alemtuzumab group. Test for significance was done by using Wilcoxon rank-sum test. Subgroup analysis considering the type of ATG used (Thymoglobulin vs. ATG Fresenius) revealed that differences between alemtuzumab and ATG group were more due to effects of ATG Fresenius than Thymoglobulin.
  
  
  CONCLUSIONS
  The use of alemtuzumab in comparison with ATG as part of the conditioning regimen may be an approach to reduce the number of transfused platelet and red cell concentrates after allogeneic stem cell transplantation.
authors.affiliation: Department of Hematology, Oncology, Transplantation, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany. thomas.neumann@uni-greifswald.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Neumann
authors.affiliation: Department of Urology, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: Laila
authors.initials: L
authors.lastname: Schneidewind
authors.affiliation: Institute of Immunology and Transfusion Medicine, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thiele
authors.affiliation: Department of Hematology, Oncology, Transplantation, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: Meike
authors.initials: M
authors.lastname: Schulze
authors.affiliation: Department of Hematology, Oncology, Transplantation, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Klenner
authors.affiliation: Department of Hematology, Oncology, Transplantation, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Busemann
authors.affiliation: Department of Hematology, Oncology, HELIOS Klinikum Bad Saarow, Bad Saarow, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Pink
authors.affiliation: Institute of Immunology and Transfusion Medicine, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
authors.affiliation: Department of Hematology, Oncology, Transplantation, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Dölken
authors.affiliation: Department of Hematology, Oncology, Transplantation, University Medical Center, Ernst-Moritz-Arndt University, Greifswald, Germany.
authors.forename: William H
authors.initials: WH
authors.lastname: Krüger
mesh_terms: D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001792:Blood Platelets / Q000166:cytology*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000473:pathology / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017713:Platelet Transfusion; D011379:Prognosis; D012189:Retrospective Studies; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D000970:Antineoplastic Agents; D000074323:Alemtuzumab; C512542:thymoglobulin
keywords: ATG; Alemtuzumab; Engraftment; Platelet; Stem cell transplantation