TY - JOUR
T1 - Pre-emptive treatment of acute GVHD
T2 - A randomized multicenter trial of rabbit anti-thymocyte globulin, given on day7 after alternative donor transplants
AU - Bacigalupo, A.
AU - Lamparelli, T.
AU - Milone, G.
AU - Sormani, M. P.
AU - Ciceri, F.
AU - Peccatori, J.
AU - Locasciulli, A.
AU - Majolino, I.
AU - Di Bartolomeo, P.
AU - Mazza, F.
AU - Sacchi, N.
AU - Pollicheni, S.
AU - Pinto, V.
PY - 2010/2
Y1 - 2010/2
N2 - We have previously shown that hemopoietic stem cell transplant (HSCT) recipients can be stratified on day + 7 as having low, intermediate or a high risk of transplant-related mortality (TRM). With the aim of reducing TRM and GVHD, intermediate and high-risk patients (n=170) were randomized to receive anti-thymocyte globulin (ATG, thymoglobuline) on day + 7 (n=84) or no treatment (n=86) (controls). There was a reduction of TRM from 35% in controls to 29% in ATG patients (P=0.3), of acute GVHD III-IV from 15 to 5% (P=0.02) and of chronic GVHD from 26 to 11% (P=0.03); survival was comparable. The predictive value of the day + 7 score on TRM was confirmed for controls (19 vs 42% for intermediate vs high risk, respectively, P=0.03), whereas ATG abrogated this predictive effect (29 vs 29%). ATG reduced GVHD (P=0.006) in high-risk patients, but not in patients with an intermediate risk. In conclusion, we confirm that TRM can be predicted on the basis of day + 7 laboratory values, after alternative donor HSCT; in high-, but not intermediate-risk patients, the administration of ATG on day + 7 reduces GVHD. These results may represent a platform for risk-adapted post transplant immune modulation.
AB - We have previously shown that hemopoietic stem cell transplant (HSCT) recipients can be stratified on day + 7 as having low, intermediate or a high risk of transplant-related mortality (TRM). With the aim of reducing TRM and GVHD, intermediate and high-risk patients (n=170) were randomized to receive anti-thymocyte globulin (ATG, thymoglobuline) on day + 7 (n=84) or no treatment (n=86) (controls). There was a reduction of TRM from 35% in controls to 29% in ATG patients (P=0.3), of acute GVHD III-IV from 15 to 5% (P=0.02) and of chronic GVHD from 26 to 11% (P=0.03); survival was comparable. The predictive value of the day + 7 score on TRM was confirmed for controls (19 vs 42% for intermediate vs high risk, respectively, P=0.03), whereas ATG abrogated this predictive effect (29 vs 29%). ATG reduced GVHD (P=0.006) in high-risk patients, but not in patients with an intermediate risk. In conclusion, we confirm that TRM can be predicted on the basis of day + 7 laboratory values, after alternative donor HSCT; in high-, but not intermediate-risk patients, the administration of ATG on day + 7 reduces GVHD. These results may represent a platform for risk-adapted post transplant immune modulation.
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U2 - 10.1038/bmt.2009.151
DO - 10.1038/bmt.2009.151
M3 - Article
C2 - 19584823
AN - SCOPUS:76749165710
VL - 45
SP - 385
EP - 391
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
SN - 0268-3369
IS - 2
ER -