title: HLA-mismatched haploidentical transplantation using low-dose anti-thymocyte globulin (ATG: thymoglobulin).
abstract: OBJECTIVE
  To clarify optimal strategies for human leukocyte antigen (HLA)-mismatched haploidentical hematopoietic stem cell transplantation (HSCT).
  
  
  METHODS
  Twelve patients who underwent HSCT from a haploidentical related donor using low-dose thymoglobulin were analyzed retrospectively. Thymoglobulin was added to conditioning regimens at 2.5 mg/kg/day for 2 days (days -4 and -3). Prophylaxis against graft-versus-host disease (GVHD) was performed with cyclosporine and methotrexate.
  
  
  RESULTS
  The median age of the patients was 33 years. Six patients had previous allogeneic HSCT, and HSCT was performed in non-remission for nine patients. All patients but one, who died due to early infection, achieved neutrophil engraftment at a median of 17 days with complete donor-type chimerism. Acute and chronic GVHD were observed in six and five patients, respectively, but no patients died of GVHD-associated complication. No one developed cytomegalovirus disease, but Epstein-Barr virus-related lymphoproliferative disorder was observed in one patient. Long-term survival in remission without immunosuppressive agents are observed in two patients who underwent HSCT in remission, but the majority of patients who underwent HSCT in non-remission experienced disease progression.
  
  
  CONCLUSIONS
  Haploidentical HSCT could be performed with thymoglobulin at 5 mg/kg, with the balance between GVHD and relapse rate. The dose reduction of thymoglobulin may be considered for advanced hematological malignancy.
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Akahoshi
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Naonori
authors.initials: N
authors.lastname: Harada
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakano
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kameda
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ugai
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Wada
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ishihara
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawamura
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Sato
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ashizawa
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Kiriko
authors.initials: K
authors.lastname: Terasako-Saito
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Shun-Ichi
authors.initials: SI
authors.lastname: Kimura
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Kikuchi
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Yamazaki
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.affiliation: a Division of Hematology, Saitama Medical Center , Jichi Medical University , Saitama , Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D018450:Disease Progression; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology*; D006239:Haplotypes; D019337:Hematologic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018183:Transplantation Chimera; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D006680:HLA Antigens; D007166:Immunosuppressive Agents; C512542:thymoglobulin
keywords: Thymoglobulin; allogeneic hematopoietic stem cell transplantation; haploidentical donor; immune reconstitution