Pre-emptive treatment of acute GVHD: a randomized multicenter trial of rabbit anti-thymocyte globulin, given on day+7 after alternative donor transplants

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 receiv...

Full description

Saved in:

Bibliographic Details
Published in:	Bone marrow transplantation (Basingstoke) Vol. 45; no. 2; pp. 385 - 391
Main Authors:	Bacigalupo, A, Lamparelli, T, Milone, G, Sormani, M P, Ciceri, F, Peccatori, J, Locasciulli, A, Majolino, I, Di Bartolomeo, P, Mazza, F, Sacchi, N, Pollicheni, S, Pinto, V
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 01-02-2010 Nature Publishing Group
Subjects:	Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Animals Antilymphocyte Serum - therapeutic use Antithymocyte globulin Biological and medical sciences Bone marrow Bone marrow, stem cells transplantation. Graft versus host reaction Care and treatment Cause of Death Cell Biology Globulins Graft versus host reaction Graft vs Host Disease - mortality Graft vs Host Disease - prevention & control Health aspects Hematologic and hematopoietic diseases Hematology Hematopoietic Stem Cell Transplantation - mortality Hematopoietic stem cells Humans Immunomodulation Internal Medicine Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis Medical sciences Medicine Medicine & Public Health Multivariate Analysis original-article Patients Public Health Rabbits Recurrence Risk Risk factors Risk groups Stem cell transplantation Stem Cells Thymocytes Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Transplants Transplants & implants Italy GVHD ATG allo BMT acute leukemia Stem cell Multicenter study Hematopoietic cell Homograft Rabbit Prevention Randomization Bone marrow Graft Clinical trial Antithymocyte globulin Immunopathology Graft versus host disease Hematology Acute Acute leukemia Malignant hemopathy Lagomorpha Vertebrata Mammalia Treatment Donor Animal Cancer
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-News-2 ObjectType-Feature-3
ISSN:	0268-3369 1476-5365
DOI:	10.1038/bmt.2009.151