Less Graft-Versus-Host Disease after Rabbit Antithymocyte Globulin Conditioning in Unrelated Bone Marrow Transplantation for Leukemia and Myelodysplasia: Comparison with Matched Related Bone Marrow TransplantationReport as inadecuate




Less Graft-Versus-Host Disease after Rabbit Antithymocyte Globulin Conditioning in Unrelated Bone Marrow Transplantation for Leukemia and Myelodysplasia: Comparison with Matched Related Bone Marrow Transplantation - Download this document for free, or read online. Document in PDF available to download.

One of the major drawbacks for unrelated donor UD bone marrow transplantation BMT is graft-versus-host disease GVHD. Despite results from randomized trials, antithymocyte globulin ATG is not routinely included for GVHD prophylaxis in UD BMT by many centers. One of ways to demonstrate the usefulness of rabbit ATG in UD BMT is to evaluate how its results approximate to those observed in matched related MRD BMT. Therefore, we compared the outcomes between UD BMT with rabbit ATG Thymoglobulin for GVHD prophylaxis n = 25 and MRD BMT n = 91 for leukemia and myelodysplasia. All but one patient received a myeloablative conditioning regimen. Grades II–IV acute GVHD were similar 39.5% vs. 36%, p = 0.83; however, MRD BMT recipients developed more moderate-severe chronic GVHD 36.5% vs. 8.6%, p = 0.01 and GVHD-related deaths 32.5% vs. 5.6%, p = 0.04. UD BMT independently protected against chronic GVHD hazard ratio 0.23, p = 0.04. The 6-month transplant-related mortality, 1-year relapse incidence, and 5-year survival rates were similar between patients with non-advanced disease in the MRD and UD BMT groups, 13.8% vs. 16.6% p = 0.50, 20.8% vs. 16.6% p = 0.37, and 57% vs. 50% p = 0.67, respectively. Stable full donor chimerism was equally achieved 71.3% vs. 71.4%, p = 1. Incorporation of rabbit ATG in UD BMT promotes less GVHD, without jeopardizing chimerism evolution, and may attain similar survival outcomes as MRD BMT for leukemia and myelodysplasia especially in patients without advanced disease.



Author: Elias Hallack Atta , Danielli Cristina Muniz de Oliveira, Luis Fernando Bouzas, Márcio Nucci, Eliana Abdelhay

Source: http://plos.srce.hr/



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