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Tian Z, Man Q, Yang Y, Guan H, Wang Y, Luo R, Wang J. Comparison of rabbit ATLG and ATG for GVHD prophylaxis in hematological malignancies with haploidentical hematopoietic stem cell transplantation. Ann Hematol 2024; 103:1729-1736. [PMID: 38538977 DOI: 10.1007/s00277-024-05724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
Rabbit anti-human T lymphocyte globulin (ATLG) and anti-thymocyte globulin (ATG) are commonly used for graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT). Yet, their efficacy and safety have seldom been compared in hematological malignancies with haploidentical HSCT. A retrospective analysis with 28 ATLG (total dosage, 20-30 mg/kg) and 18 ATG (total dosage, 8-10 mg/kg) patients were performed. The cumulative incidences of chronic GVHD and relapse were comparable between both groups. ATLG showed a trend towards a lower acute GVHD incidence (28.6% vs. 44.4%, P = 0.242) and 3-year non-relapse mortality (10.7% vs. 27.8%, P = 0.160), and had a significantly higher 3-year overall survival (OS, 64.3% vs. 33.3%, P = 0.033) and GVHD-free and relapse-free survival (GRFS, 32.1% vs. 11.1%, P = 0.045) compared with ATG. Multivariate Cox regression analysis demonstrated ATLG was independently associated with a favorable OS (hazard ratio [HR] = 0.37, 95% confidence interval [CI]: 0.16-0.86, P = 0.020) and GRFS (HR = 0.51, 95%CI: 0.26-1.00, P = 0.051). Furthermore, ATLG had a lower risk of fever (25.0% vs. 61.1%, P = 0.014) and hemorrhage cystitis (7.1% vs. 38.9%, P = 0.008) than ATG-T. In conclusion, ATLG confers more survival benefit and a better safety profile than ATG and can be used in hematological malignancies with haploidentical HSCT. Prospective designed trials with a larger sample size are warranted to confirm the results in the future.
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Affiliation(s)
- Zhengqin Tian
- Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China
| | - Qihang Man
- Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China
| | - Yixin Yang
- Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China
| | - Hexian Guan
- Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China
| | - Ying Wang
- Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China
| | - Rongmu Luo
- Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China.
- Department of Hematology, China Aerospace Science & Industry Corporation 731 Hospital, Fengtai District, Beijing, 100074, China.
| | - Jingbo Wang
- Department of Hematology, Aerospace Center Hospital, Haidian District, Beijing, 100049, China.
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Thukral S, Rokde R, Ray DS. Comparison of Thymoglobulin and Grafalon as Induction Agents in Renal Transplantation: A Prospective Study. Transplant Proc 2022; 54:2133-2139. [PMID: 36116944 DOI: 10.1016/j.transproceed.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Induction immunosuppression is used to reduce the incidence of acute rejection and prevent delayed graft function. The 2 rabbit anti-thymocyte globulins- thymoglobulin and Grafalon (ATG Fresenius) have been commonly used for induction immunosuppression and treatment of acute rejection in solid organ transplantation. There are very few studies comparing the efficacy and side effects of both the anti-thymocyte globulins therefore this prospective study comparing the 2 types of anti-thymocyte globulins would be of clinical interest. PATIENTS AND METHODS This prospective single center study was conducted at Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India from April 2019 to June 2020. Sixty-two ABO-compatible renal transplant recipients were included in the study. They were divided in 2 groups of 31 patients each. One group received thymoglobulin (3 mg/kg) and the second group received Grafalon (6 mg/kg). All patients were followed up for 12 months and the 2 groups were compared for incidence of rejections, infections, graft function, patient survival, and graft survival. RESULTS There was no significant difference in the incidence of rejections, infective episodes, graft function, posttransplant diabetes mellitus, graft survival and patient survival in thymoglobulin or Grafalon groups. The hematological parameters were similar in both groups at 7 days, 1 month, and 6 months of follow-up. The absolute lymphocyte count was significantly lower in the thymoglobulin group at 12 months posttransplant. CONCLUSIONS Thymoglobulin and Grafalon were found to be equivalent in terms of safety and efficacy in short term, with no difference in rejections, infections, graft survival, or patient survival.
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Affiliation(s)
- Sharmila Thukral
- Rabindranath Tagore Hospital (Narayana Health Hospitals), Kolkata, India
| | - Ratnesh Rokde
- Department of Nephrology and Transplantation, Rabindranath Tagore Hospital (Narayana Health Hospitals), Kolkata, India
| | - Deepak Shankar Ray
- Department of Nephrology and Transplantation, Rabindranath Tagore Hospital (Narayana Health Hospitals), Kolkata, India.
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Zhang Y, Liu L, Si Y, Miao M, Qiu H, Tang X, Han Y, Fu C, Jin Z, Chen S, Sun A, Wu D. A comparative study of porcine antihuman lymphocyte globulin versus antithymocyte globulin-fresenius in an allogeneic hematopoietic cell transplantation conditioning regimen for severe aplastic anemia. ACTA ACUST UNITED AC 2021; 26:741-750. [PMID: 34555301 DOI: 10.1080/16078454.2021.1974201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare the outcomes of antihuman T lymphocyte globulin (ATG-F) and porcine antihuman lymphocyte globulin (p-ALG) as part of a conditioning regimen in hematopoietic stem cell transplantation (HSCT) for severe aplastic anemia (SAA). METHODS we performed a retrospective analysis, evaluating the outcome of patients with SAA who received ATG-F based conditioning (n = 26) with those receiving p-ALG conditioning (n = 34). RESULTS The median time to neutrophil engraftment was 11 days (range, 8 - 38) and 11 days (range, 9 - 24) in the p-ALG and ATG-F groups (P = 0.857); the median platelet engraftment time was 15 (range, 9 - 330) days and 13 (range, 10 - 56) days (P = 0.155). There were no significant differences in grades II - IV acute graft-versus-host disease (aGVHD), grades III - IV aGVHD, chronic GVHD (cGVHD), and the moderate-severe cGVHD between the ATG-F and p-ALG groups (P>0.05). DISCUSSION Patients in the ATG-F group functioned significantly better on role-physical (P = 0.006), general health (P = 0.029), and physical component summary (P = 0.009). The estimated overall survival and failure free survival rates at 5 years were 88.5% ± 6.3% vs. 82.4% ± 6.5% (P = 0.515), 84.6% ± 7.1% vs. 79.4% ± 6.9%, respectively (P = 0.579). The infection rates were 61.53% and 47.05%, respectively (P = 0.265). CONCLUSION As part of the conditioning regimen, p-ALG achieved a similar efficacy as ATG-F without increasing the incidence of transplantation complications in SAA patients.
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Affiliation(s)
- Yanming Zhang
- Department of Hematology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, People's Republic of China.,The Second People's Hospital of Huai'an, Huai'an, People's Republic of China
| | - Limin Liu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Yejun Si
- Department of Hematology, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, People's Republic of China.,The Second People's Hospital of Huai'an, Huai'an, People's Republic of China
| | - Miao Miao
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Huiying Qiu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Xiaowen Tang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Yue Han
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Chengcheng Fu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Zhengming Jin
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Suning Chen
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Aining Sun
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.,Institute of Blood and Marrow Transplantation of Soochow University, Suzhou, People's Republic of China
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Comparison of ATG-thymoglobulin with ATG-Fresenius for Epstein-Barr virus infections and graft-versus-host-disease in patients with hematological malignances after haploidentical hematopoietic stem cell transplantation: a single-center experience. Ann Hematol 2020; 99:1389-1400. [PMID: 32291495 PMCID: PMC7222941 DOI: 10.1007/s00277-020-04014-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/28/2020] [Indexed: 01/24/2023]
Abstract
Two anti-thymocyte globulin (ATG) forms are used in graft-versus-host disease (GVHD) prophylaxis during haploidentical hematopoietic stem cell transplantations (haplo-HSCTs): ATG-thymoglobulin (ATG-T) and ATG-fresenious (ATG-F). However, comparable dosages for haplo-HSCT remain unclear. We compared and evaluated the effects of ATG-T (7.5 mg/kg) or ATG-F (20 mg/kg) dosages in a relatively homogenous population in haplotype HSCT settings. Patients administered ATG-T 7.5 mg/kg (n = 81) or ATG-F 20 mg/kg (n = 35) as part of GVHD prophylaxis during haplo-HSCT were enrolled. Incidence and severity of GVHD, Epstein–Barr virus (EBV) infection, and immune cell recovery were compared using the Mann-Whitney U rank test and chi-square test. Cumulative incidences of GVHD, EBV infection and its subgroups, and relapse mortality were computed; overall survival (OS) was analyzed using the Kaplan-Meier method, with the log-rank test used for univariate comparison. Risk factors for OS were analyzed by the Cox proportional hazards model. Incidence and cumulative incidence of all grades of acute GVHD and subgroups were comparable in both groups (all p > 0.05); however, cumulative incidence of any grade and limited chronic GVHD was significantly higher in the ATG-T group (p = 0.002, p = 0.007, respectively). Cumulative incidences of EBV infections, EBV-DNAemia, and EBV-related diseases were similar; relapse mortality and OS rates were comparable between both groups (all p > 0.05). ATG-T dosage (7.5 mg/kg) appeared comparable to ATG-F dosage (20 mg/kg) for haplo-HSCT. Currently approved ATG-T and ATG-F doses appear efficient to balance the risk–benefit ratio of GVHD, OS, relapse mortality, and EBV infection in haplo-HSCT.
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Fludarabine/busulfan versus fludarabine/total-body-irradiation (2 Gy) as conditioning prior to allogeneic stem cell transplantation in patients (≥60 years) with acute myelogenous leukemia: a study of the acute leukemia working party of the EBMT. Bone Marrow Transplant 2019; 55:729-739. [PMID: 31645668 DOI: 10.1038/s41409-019-0720-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 12/16/2022]
Abstract
Nonmyeloablative (NMA) conditioning regimens facilitate allogeneic stem cell transplantation (alloSCT) in elderly patients and/or in those with comorbidities. The acute leukemia working party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT) compared the outcomes of patients ≥60 years with AML in first complete remission (CR1), that had received an alloSCT following NMA conditioning, i.e. either fludarabine/busulfan (FB2) or fludarabine/total-body-irradiation-2Gy (FluTBI2Gy). A total of 1088 patients were included (median age 65 years). Donors were matched siblings (MSD) and matched unrelated donors (MUD) in 47% and 53%, respectively. In vivo T-cell depletion (TCD) was applied to 79% and none (0%) of patients in the FB2 and FluTBI2Gy groups, respectively. In the MSD group we found a trend for less extensive cGVHD in patients receiving FB2 with in vivo TCD, HR: 0.49, p = 0.08, and in those without worse NRM, HR: 2.14, p = 0.04, and a trend for more total cGVHD, HR: 1.61, p = 0.09. Patients transplanted from MUDs had a significantly higher incidence of total cGVHD, extensive cGVHD and a worse GRFS with FluTBI2Gy in comparison to FB2, HR: 2.44; p < 0.0001; HR 4.59; p < 0.00001 and HR: 1.35; p = 0.03, respectively. No differences were observed with respect to LFS, OS, RI, NRM, and aGVHD.
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Ducloux D, Bamoulid J, Daguindau E, Rebibou JM, Courivaud C, Saas P. Antithymocytes globulins: Time to revisit its use in kidney transplantation? Int Rev Immunol 2018; 37:183-191. [DOI: 10.1080/08830185.2018.1455194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- D. Ducloux
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, Interactions hôte-greffon-tumeur, Federation hospitalo-universitaire INCREASE, LabEX LipSTIC, Besançon, France
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - J. Bamoulid
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, Interactions hôte-greffon-tumeur, Federation hospitalo-universitaire INCREASE, LabEX LipSTIC, Besançon, France
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - E. Daguindau
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, Interactions hôte-greffon-tumeur, Federation hospitalo-universitaire INCREASE, LabEX LipSTIC, Besançon, France
- Department of Hematology, CHU Besançon, Besançon, France
| | - J. M. Rebibou
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, Interactions hôte-greffon-tumeur, Federation hospitalo-universitaire INCREASE, LabEX LipSTIC, Besançon, France
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Dijon, Dijon, France
| | - C. Courivaud
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, Interactions hôte-greffon-tumeur, Federation hospitalo-universitaire INCREASE, LabEX LipSTIC, Besançon, France
- Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France
| | - P. Saas
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, Interactions hôte-greffon-tumeur, Federation hospitalo-universitaire INCREASE, LabEX LipSTIC, Besançon, France
- INSERM, CHU Besançon, Besançon, France
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Ariza-Heredia EJ, Chemaly RF, Shahani LR, Jang Y, Champlin RE, Mulanovich VE. Delay of alternative antiviral therapy and poor outcomes of acyclovir-resistant herpes simplex virus infections in recipients of allogeneic stem cell transplant - a retrospective study. Transpl Int 2018; 31:639-648. [PMID: 29464765 DOI: 10.1111/tri.13142] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/23/2017] [Accepted: 02/14/2018] [Indexed: 12/16/2022]
Abstract
Acyclovir is commonly used to prevent and treat herpes simplex virus (HSV) reactivation after hematopoietic cell transplant (HCT), and only few reports have been published on acyclovir-resistant HSV in HCT recipients. We reviewed the medical records of patients with a microbiologic diagnosis of acyclovir-resistant HSV by plaque reduction test who received an HCT from 2002 through 2014. A total of 4 028 HCTs were performed during the study period, and 18 of the recipients met the diagnostic criteria for acyclovir-resistant HSV. All cases had undergone allogeneic HCTs. Most patients were in the pre-engraftment period or on systemic corticosteroid therapy for graft-versus-host disease (GVHD). The median time between diagnosis and susceptibility testing was 15 days, and antiviral therapy was changed at a median of 27 days. Patients required prolonged therapy (~80 days), and many had serious complications including renal failure and hospitalization. In conclusion, acyclovir-resistant HSV infection is more likely during the period of profound deficit in T-cell-mediated immunity and is associated with significant morbidities. Higher doses of acyclovir prophylaxis might be needed for patients with history of HSV during pre-engraftment or GVHD treatment. In patients who do not respond or progress after 1 week of acyclovir therapy, testing for drug-resistant HSV, and early switch to an alternative antiviral should be considered.
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Affiliation(s)
- Ella J Ariza-Heredia
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lokesh R Shahani
- McGovern Medical School, The University of Texas Science Center at Houston, Houston, TX, USA
| | - Ying Jang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Polverelli N, Malagola M, Turra A, Skert C, Perucca S, Chiarini M, Cattina F, Rambaldi B, Cancelli V, Morello E, Schieppati F, Bernardi S, Zanaglio C, Sottini A, Giustini V, Imberti L, Montanelli A, Russo D. Comparative study on ATG-thymoglobulin versus ATG-fresenius for the graft-versus-host disease (GVHD) prophylaxis in allogeneic stem cell transplantation from matched unrelated donor: a single-centre experience over the contemporary years. Leuk Lymphoma 2018. [PMID: 29527964 DOI: 10.1080/10428194.2018.1439584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Nicola Polverelli
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Michele Malagola
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Alessandro Turra
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Cristina Skert
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Simone Perucca
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy.,b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Marco Chiarini
- c Clinical Chemistry Laboratory, Department of Diagnostics , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Federica Cattina
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Benedetta Rambaldi
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Valeria Cancelli
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Enrico Morello
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Francesca Schieppati
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
| | - Simona Bernardi
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy.,b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Camilla Zanaglio
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy.,b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Alessandra Sottini
- b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Viviana Giustini
- b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Luisa Imberti
- b Laboratorio CREA (Centro di Ricerca Emato-oncologica AIL) , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Alessandro Montanelli
- c Clinical Chemistry Laboratory, Department of Diagnostics , ASST Spedali Civili of Brescia , Brescia , Italy
| | - Domenico Russo
- a Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences , University of Brescia, ASST Spedali Civili of Brescia , Brescia , Italy
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Busca A, Aversa F. In-vivo or ex-vivo T cell depletion or both to prevent graft-versus-host disease after hematopoietic stem cell transplantation. Expert Opin Biol Ther 2017; 17:1401-1415. [PMID: 28846051 DOI: 10.1080/14712598.2017.1369949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation (HSCT) represents a widely accepted therapeutic strategy for the treatment of hematologic disorders which are otherwise considered incurable. Alloreactive T cells infused with the stem cell inoculum may generate graft-versus-host disease (GVHD) representing one the most relevant obstacles to the successful outcome of patients receiving allogeneic HSCT. Areas covered: In this review, the authors provide an overview of the most recent approaches of T-cell depletion (TCD) including ex-vivo αβ+ TCD and in-vivo TCD with anti-thymocyte globulin (ATG). Expert opinion: Ex vivo depletion of donor T-cells prevents both acute and chronic GVHD without the need for any additional posttransplant immunological prophylaxis either in haploidentical HSCT and HLA matched transplants. Three prospective trials evaluating the efficacy of ATG in matched unrelated donor transplant recipients demonstrated that ATG reduces the incidence of both acute and chronic GVHD without a significant increase of relapse rate, and similar results have been reported in the setting of blood stem cell grafts from matched sibling donors.
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Affiliation(s)
- Alessandro Busca
- a SSD Trapianto di Cellule Staminali , AOU Citta' della Salute e della Scienza , Torino , Italy
| | - Franco Aversa
- b Hematology and BMT Unit , University of Parma , Parma , Italy
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