Low-dose antithymocyte globulin inhibits chronic graft-versus-host disease in peripheral blood stem cell transplantation from unrelated donors

• Published in: Bone marrow transplantation (Basingstoke) Vol. 56; no. 9; pp. 2231 - 2240
• Main Authors: Shiratori, Souichi, Sugita, Junichi, Fuji, Shigeo, Aoki, Jun, Sawa, Masashi, Ozawa, Yukiyasu, Hashimoto, Daigo, Matsuoka, Ken-ichi, Imada, Kazunori, Doki, Noriko, Ashida, Takashi, Ueda, Yasunori, Tanaka, Masatsugu, Sawayama, Yasushi, Ichinohe, Tatsuo, Terakura, Seitaro, Morishima, Satoko, Atsuta, Yoshiko, Fukuda, Takahiro, Teshima, Takanori
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2021; Nature Publishing Group
• Subjects: 631/250/1904; 692/308/2779/109; 692/699/1541/1990; Animals; Antilymphocyte serum; Antilymphocyte Serum - therapeutic use; Antithymocyte globulin; Blood; Cell Biology; Cell number; Dosage and administration; Drug therapy; Globulins; Graft versus host disease; Graft versus host reaction; Graft vs Host Disease - prevention & control; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Humans; Internal Medicine; Lymphocytes; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local; Patient outcomes; Peripheral blood; Peripheral Blood Stem Cell Transplantation; Prevention; Public Health; Rabbits; Retrospective Studies; Stem cell transplantation; Stem Cells; Survival; Thymocytes; Thymoglobulin; Transplantation; Transplantation Conditioning; Unrelated Donors; Japan
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-021-01314-w

Antithymocyte globulin (ATG) has been shown to reduce chronic graft-versus-host disease (GVHD) particularly in allogeneic peripheral blood stem cell transplantation (PBSCT) from unrelated donors; however, anti-GVHD effects of lower doses of ATG remains to be elucidated. We conducted a nationwide retrospective study to compare the outcomes of unrelated PBSCT with or without rabbit ATG (thymoglobulin) in 287 patients. A median ATG dose was 2.0 mg/kg. The primary endpoint, the cumulative incidence of moderate–severe chronic GVHD at 2 years was 22.1% in the ATG group, which was significantly less than that in the non-ATG group (36.3%, P  = 0.025). The ATG group had a higher incidence of immunosuppressant discontinuation, GVHD-free, relapse-free survival, and moderate–severe chronic GVHD-free, relapse-free survival at 2 years compared to the non-ATG group. The incidences of grade III–IV aGVHD and moderate–severe chronic GVHD were significantly higher in patients with high absolute lymphocyte count (ALC) before the administration of ATG, whereas relapse rate was significantly higher in patients with low ALC before ATG. In conclusion, low-dose ATG effectively suppresses chronic GVHD in unrelated PBSCT, and ALC before ATG may be a potential predictor for GVHD and relapse.