Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia.
For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17%versus6%,P<0.001) and chronic (20%versus9%,P<0.001) graft-versus-host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%,P=0.76, respectively. Among recipients of unrelated donor transplants, acute graft-versus-host disease was also higher with horse compared to rabbit antithymocyte globulin (42%versus23%,P<0.001) but not chronic graft-versus-host disease (38%versus32%,P=0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75%versus83%,P=0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.
Division of Hematology, The Ottawa Hospital, ON, Canada.
Natasha
N
Kekre
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
Ying
Y
Zhang
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.|Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Mei-Jie
MJ
Zhang
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Jeanette
J
Carreras
Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan.
Parvez
P
Ahmed
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Paolo
P
Anderlini
Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
Elias Hallack
EH
Atta
Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
Mouhab
M
Ayas
Department of Pediatrics, University Medical Center Utrecht, The Netherlands.
Jaap Jan
JJ
Boelens
Hospital de Clinicas, Federal University of Parana, Curitiba, Brazil.
Carmem
C
Bonfim
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
H Joachim
HJ
Deeg
Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, CA, USA.
Neena
N
Kapoor
BMT Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
Jong-Wook
JW
Lee
Department of Hematology & Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA.
Ryotaro
R
Nakamura
Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Hospital Los Angeles, CA, USA.
Michael A
MA
Pulsipher
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA meapen@mcw.edu.
Mary
M
Eapen
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA.
Joseph H
JH
Antin
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods; D015897:Comorbidity; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006650:Histocompatibility Testing; D006801:Humans; D007239:Infections / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D035781:Siblings; D016019:Survival Analysis; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
D000961:Antilymphocyte Serum