title: Meta-analysis of the actions of antithymocyte globulin in patients undergoing allogeneic hematopoietic cell transplantation.
abstract: Graft-versus-host disease (GVHD) is a serious complication associated with allogeneic hematopoietic cell transplantation (allo-HCT). Antithymocyte globulin (ATG) is widely used prior to allo-HCT for GVHD prevention, though evidence of its efficacy remains unclear. We therefore identified nine randomized controlled trials (RCTs), enrolling 1089 patients (554 in the ATG group and 535 in the non-ATG group) to conduct a meta-analysis of the actions of ATG in allo-HCT. A relative risk or risk ratio (RR) and 95% confidence interval (CI) were calculated for each outcome. Rabbit ATG reduced overall acute (a) GVHD (RR 0.77, 95% CI 0.67-0.89, P = 0.0004), grade III-IV aGVHD (RR 0.53, 95% CI 0.32-0.88, P = 0.01), overall chronic (c) GVHD (RR 0.52, 95% CI 0.42-0.64, P < 0.00001) and extensive cGVHD (RR 0.28, 95% CI 0.18-0.43, P < 0.00001), without increased risk of relapse (RR 1.17, 95% CI 0.91-1.49, P = 0.23). By contrast, horse ATG did not reduce overall aGVHD (RR 1.25, 95% CI 0.88-1.79, P = 0.22) or cGVHD (RR 1.67, 95% CI 0.96-2.91, P = 0.07). ATG marginally reduced 100-day transplant related mortality (RR 0.75, 95% CI 0.56-1.00, P = 0.05) without compromising overall survival or increased risk of infections. Further studies are required to evaluate the optimal dosage and formulation of ATG in different conditioning regimens of transplantation with varied sources of graft and donor.
authors.affiliation: Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China.
authors.forename: Jiaojiao
authors.initials: J
authors.lastname: Yuan
authors.affiliation: Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China.
authors.forename: Renzhi
authors.initials: R
authors.lastname: Pei
authors.affiliation: Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China.
authors.forename: Wensi
authors.initials: W
authors.lastname: Su
authors.affiliation: Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China.
authors.forename: Junjie
authors.initials: J
authors.lastname: Cao
authors.affiliation: Department of Hematology, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang, P.R. China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lu
mesh_terms: D000208:Acute Disease; D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006736:Horses; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011817:Rabbits; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum
keywords: Immune response; Immunity; Immunology and Microbiology Section; allogeneic hematopoietic cell transplantation; antithymocyte globulin; graft-versus-host disease; meta-analysis