Anti-Thymocyte-Globulin as part of the preparative regimen prevents graft failure and severe Graft versus Host disease (GvHD) in allogeneic stem cell transplantation from unrelated donors

被引:39
作者
Kröger, N
Zabelina, T
Krüger, W
Renges, H
Stute, N
Dürken, M
von Finkenstein, FG
Erttmann, R
Kabisch, H
Schafhausen, P
Jaburg, N
Löliger, C
Zander, AR
机构
[1] Univ Hamburg, Hosp Eppendorf, Dept Bone Marrow Transplantat, D-20246 Hamburg, Germany
[2] Univ Hamburg, Dept Transfus Med, Hamburg, Germany
[3] Pavlow Univ, Dept Bone Marrow Transplantat, St Petersburg, Russia
关键词
anti-thymocyte-globulin; unrelated bone marrow transplantation; Graft versus Host disease;
D O I
10.1007/s002770000269
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
To reduce the incidence of GvHD and the rate of graft failure in unrelated stem cell transplantation, we incorporate anti-thymocyte globulin in the preparative regimen in 98 patients with hematological or inherited storage disease. The median age was 32 years (range: 1-56) and 84 patients underwent transplantation from HLA-A,-B and DR identical donor, while in 14 patients the donor were mismatched either in HLA- A, -B or -DR locus. Only one patient with chronic myelocytic leukemia (CML) and blast crisis had a primary graft failure (1%). Grade II-IV acute GVHD occurred in 37 patients (37%), grade III/IV GVHD developed in 15 patients (15%). Chronic GvHD was observed in 29%, and only 12 patients had extensive GVHD (17%). After a median follow-up of 34 months (range, 9-90), the estimated overall survival at 3 years for all patients is 58% (CI 95%: 48%-68%), and the estimated disease-free survival at 3 years is 49% (CI 95%: 38%-60%). For patients with CML transplanted in first chronic phase or accelerated phase (n=40), the estimated overall survival at 3 pears is 70% (CI 95%: 56%-84%), and the estimated disease-free survival at 3 years is 58% (CI 95%: 17%-85%). ATG in unrelated stem cell transplantation reduces the risk of severe acute and chronic GVHD and of graft failure without an obvious increase of severe infection. Further follow-up is mandatory to determine the incidence of late relapse.
引用
收藏
页码:209 / 215
页数:7
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