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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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2
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Wang L, Kong P, Zhang C, Gao L, Zhu L, Liu J, Gao S, Chen T, Liu H, Yao H, Liu Y, Feng Y, Zhao L, Li Y, Gao L, Zhang X. Outcomes of patients with hematological malignancies who undergo unrelated donor hematopoietic stem cell transplantation with ATG-Fresenius versus ATG-Genzyme. Ann Hematol 2023; 102:1569-1579. [PMID: 37097455 PMCID: PMC10182153 DOI: 10.1007/s00277-023-05220-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
To compare the outcomes of patients with hematological malignancies who received ATG-Fresenius (ATG-F) 20 mg/kg versus those who received ATG-Genzyme (ATG-G) 10 mg/kg in an unrelated donor hematopoietic stem cell transplantation (HSCT) procedure, a total of 186 patients who underwent their first allogeneic HSCT with an unrelated donor were retrospectively analyzed. One hundred and seven patients received ATG-F, and seventy-nine patients received ATG-G. Multivariate analysis showed that the type of ATG preparation had no effect on neutrophil engraftment (P = 0.61), cumulative incidence of relapse (P = 0.092), nonrelapse mortality (P = 0.44), grade II-IV acute graft-versus-host disease (GVHD) (P = 0.47), chronic GVHD (P = 0.29), overall survival (P = 0.795), recurrence-free survival (P = 0.945) or GVHD-free relapse-free survival (P = 0.082). ATG-G was associated with a lower risk of extensive chronic GVHD and a higher risk of cytomegaloviremia (P = 0.01 and HR = 0.41, P < 0.001 and HR = 4.244, respectively). The results of this study suggest that the preparation of rabbit ATG used for unrelated HSCT should be selected based on the incidence of extensive chronic GVHD of each center, and the posttransplant management strategy should be adjusted according to the ATG preparation.
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Affiliation(s)
- Lu Wang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Peiyan Kong
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Cheng Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lidan Zhu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Jia Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shichun Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ting Chen
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Huanfeng Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Han Yao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuqing Liu
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yimei Feng
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lu Zhao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuxia Li
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Lei Gao
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China.
| | - Xi Zhang
- Medical Center of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
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3
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Jullien M, Guillaume T, Peterlin P, Garnier A, Le Bourgeois A, Debord C, Mahe B, Dubruille V, Wuilleme S, Blin N, Touzeau C, Gastinne T, Tessoulin B, Le Bris Y, Eveillard M, Duquesne A, Moreau P, Le Gouill S, Bene MC, Chevallier P. Antithymocyte globulin administration in patients with profound lymphopenia receiving a PBSC purine analog/busulfan-based conditioning regimen allograft. Sci Rep 2020; 10:15399. [PMID: 32958816 PMCID: PMC7505958 DOI: 10.1038/s41598-020-72415-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022] Open
Abstract
Graft-versus host disease (GVHD) remains one of the main causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (ASCT). Prophylactic T cell depletion via antithymocyte globulin (ATG) during ASCT conditioning is one of the standards of care for GVHD prophylaxis, although the optimal dosing strategy is still unclear. Recent studies have reported that absolute lymphocyte count at the time of ATG administration could predict survivals in ASCT from unrelated donors. Here this issue was examined in 116 patients receiving peripheral blood stem cells (PBSC) ASCT with purine analog/busulfan-based conditioning regimens between 2009 and 2019 in our department. The impact of lymphopenia at the time of ATG administration was evaluated in terms of overall survival, disease-free survival and GVHD-free/relapse-free survival. After a median follow-up of 4 years, no adverse effect of a profound lymphopenia was observed on patients' outcome. Notably, a reduced dose of ATG in patients with profound lymphopenia did not translate into better survivals. This study indicates that ATG can be administered whatever the recipient's lymphocyte counts in patients receiving a PBSC purine analog/busulfan-based conditioning regimen ASCT.
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Affiliation(s)
- Maxime Jullien
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France.
| | - Thierry Guillaume
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Pierre Peterlin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Alice Garnier
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Amandine Le Bourgeois
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Camille Debord
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Beatrice Mahe
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Viviane Dubruille
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Soraya Wuilleme
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Nicolas Blin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Cyrille Touzeau
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Thomas Gastinne
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Benoit Tessoulin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Yannick Le Bris
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | | | - Philippe Moreau
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Steven Le Gouill
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Marie C Bene
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Patrice Chevallier
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
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Dou L, Hou C, Ma C, Li F, Gao X, Huang W, Wang S, Gao C, Yu L, Liu D. Reduced risk of chronic GVHD by low-dose rATG in adult matched sibling donor peripheral blood stem cell transplantation for hematologic malignancies. Ann Hematol 2019; 99:167-179. [PMID: 31828376 PMCID: PMC6944670 DOI: 10.1007/s00277-019-03884-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/03/2019] [Indexed: 02/01/2023]
Abstract
The optimal rabbit anti-thymocyte globulin (rATG) graft-versus-host disease (GVHD) prophylaxis regimen in matched sibling donor peripheral blood stem cell transplantation (MSD-PBSCT) remains to be elucidated. In this prospective study, we used low-dose rATG for GVHD prophylaxis in patients or donors aged ≥ 40 years with hematological malignancies receiving MSD-PBSCT. rATG was administered to 40 patients at an intravenous dose of 5 mg/kg divided over day 5 and day 4 before graft infusion. No graft failure occurred. Median times to leukocyte engraftment and platelet engraftment were 11.0 days and 13.9 days. The cumulative incidence of grades 2–4 and grades 3–4 acute GVHD at day +100 was 30.0% and 2.6%. The 2-year cumulative incidence of extensive chronic GVHD and severe chronic GVHD was 11.4% and 14.7%. 93.5% (29/31) of patients had discontinued immunosuppressive medication within 3 years after transplantation. The 2-year cumulative incidence of transplant-related mortality (TRM) and relapse was 14.0% and 22.6%. The cumulative incidence of cytomegalovirus reactivation, Epstein–Barr virus reactivation, and fungal infection was 22.3%, 12.9%, and 12.5%. Kaplan–Meier estimates for overall survival, disease-free survival, and GVHD-free and relapse-free survival 3 years after transplantation were 68.9%, 68.9%, and 54.0%. rATG for GVHD prophylaxis is tolerable and efficacious at a 5 mg/kg total dose administered over 2 days (days −5 to −4) in patients receiving allogeneic MSD-PBSCT.
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Affiliation(s)
- Liping Dou
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Cheng Hou
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Chao Ma
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Fei Li
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Xiaoning Gao
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Wenrong Huang
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Shuhong Wang
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Chunji Gao
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Li Yu
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China
| | - Daihong Liu
- Department of Hematology, Chinese PLA General Hospital, Fuxing Road 28th, Haidian District, Beijing, 100853, China.
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5
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Sun Y, Wei C, Cao C, Tan X, Zeng H, Luo Y, Chen L. New Strategy of Acute Graft-vs-Host Disease: Investigation of a Reduced Dose of Antithymocyte Globulin in Haploidentical Hematopoietic Stem Cell Transplantation. Transplant Proc 2019; 51:890-895. [PMID: 30979481 DOI: 10.1016/j.transproceed.2018.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/05/2018] [Accepted: 10/09/2018] [Indexed: 12/11/2022]
Abstract
Graft-vs-host disease (GVHD) is one of the biggest challenges in haploidentical hematopoietic stem cell transplantation. Antithymocyte globulins (ATGs) are widely used to overcome GVHD, but excessive immunosuppression increases the chances of relapse and infection following transplantation. No defined standard of the appropriate dose of ATG usage is recognized. The study included 11 patients who were treated with a reduced dose of ATG to prevent GVHD in haploidentical hematopoietic stem cell transplantation. A reduced dose of ATG-Thymoglobulin (total dose of 5 mg/kg) was used in the pretreatment protocol for 2 consecutive days. All patients had successful transplantation. The median time of neutrophil engraftment was 12 days. All chimerism tests passed on day 30, 60, and 90 post transplantation. None of the patients had acute GVHD, while only 2 patients had I to II degree chronic GVHD (18.2%). No transplantation-related deaths were observed. The current findings suggest that the reduced dose of ATG can effectively prevent the incidence of acute GVHD in haploidentical hematopoietic stem cell transplantation.
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Affiliation(s)
- Y Sun
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - C Wei
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - C Cao
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - X Tan
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - H Zeng
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Y Luo
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - L Chen
- Department of Hematology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China.
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6
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Oostenbrink LVE, Jol-van der Zijde CM, Kielsen K, Jansen-Hoogendijk AM, Ifversen M, Müller KG, Lankester AC, van Halteren AGS, Bredius RGM, Schilham MW, van Tol MJD. Differential Elimination of Anti-Thymocyte Globulin of Fresenius and Genzyme Impacts T-Cell Reconstitution After Hematopoietic Stem Cell Transplantation. Front Immunol 2019; 10:315. [PMID: 30894854 PMCID: PMC6414431 DOI: 10.3389/fimmu.2019.00315] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/06/2019] [Indexed: 01/11/2023] Open
Abstract
Anti-thymocyte globulin (ATG) is a lymphocyte depleting agent applied in hematopoietic stem cell transplantation (HSCT) to prevent rejection and Graft-vs.-Host Disease (GvHD). In this study, we compared two rabbit ATG products, ATG-Genzyme (ATG-GENZ), and ATG-Fresenius (ATG-FRES), with respect to dosing, clearance of the active lymphocyte binding component, post-HSCT immune reconstitution and clinical outcome. Fifty-eigth pediatric acute leukemia patients (n = 42 ATG-GENZ, n = 16 ATG-FRES), who received a non-depleted bone marrow or peripheral blood stem cell graft from an unrelated donor were included. ATG-GENZ was given at a dosage of 6-10 mg/kg; ATG-FRES at 45-60 mg/kg. The active component of ATG from both products was cleared at different rates. Within the ATG-FRES dose range no differences were found in clearance of active ATG or T-cell re-appearance. However, the high dosage of ATG-GENZ (10 mg/kg), in contrast to the low dosage (6-8 mg/kg), correlated with prolonged persistence of active ATG and delayed T-cell reconstitution. Occurrence of serious acute GvHD (grade III-IV) was highest in the ATG-GENZ-low dosage group. These results imply that dosing of ATG-GENZ is more critical than dosing of ATG-FRES due to the difference in clearance of active ATG. This should be taken into account when designing clinical protocols.
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Affiliation(s)
| | | | - Katrine Kielsen
- Institute for Inflammation Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Marianne Ifversen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Klaus G Müller
- Institute for Inflammation Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Arjan C Lankester
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Robbert G M Bredius
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Marco W Schilham
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Maarten J D van Tol
- Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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7
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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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8
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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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