CEMO, National Cancer Institute, Rio de Janeiro, Brazil.
Biol Blood Marrow Transplant. 2012 Dec;18(12):1876-82. doi: 10.1016/j.bbmt.2012.07.004. Epub 2012 Jul 11.
The standard regimen for HLA-identical sibling bone marrow transplant (BMT) in severe aplastic anemia (SAA) is cyclophosphamide (Cy) and horse antithymocyte globulin (ATG). Horse ATG has been replaced by rabbit ATG in many countries due to the unavailability of the former product. This study was designed to assess if these ATG preparations are interchangeable in the preparative regimen for matched related BMT in SAA. Forty consecutive BMTs were retrospectively analyzed: 20 received Cy plus horse ATG and 20 received Cy plus rabbit ATG as the preparative regimen. Conditioning with rabbit ATG was protective against acute graft-versus-host disease (aGVHD) grades II-IV and moderate-severe chronic GVHD (cGVHD), with incidence rates of 0% versus 35.2% (P = .009) and 0% versus 34.0% (P = .04), respectively. On day +100, the probability of proven/probable invasive fungal disease (IFD) was higher in patients conditioned with rabbit ATG, 31.2% versus 5.5%, respectively (P = .04). Earlier cytomegalovirus (CMV) reactivation (40 versus 50 days; P = .02) was observed with rabbit ATG. An inferior lymphocyte count on days +30 (0.360 versus 0.814 × 10(9)/L; P = .01) and +90 (0.744 versus 1.330 × 10(9)/L; P = .006) was noticed in recipients of rabbit ATG. The incidence of stable mixed chimerism was higher in recipients of rabbit ATG (18.2% versus 80%, respectively; P = .004). These results suggest that horse and rabbit ATG preparations have different biological and clinical properties and should not be used interchangeably in the preparative regimen for related BMT in SAA.
在重型再生障碍性贫血（SAA）的 HLA 同胞骨髓移植（BMT）标准方案中，环磷酰胺（Cy）和马抗胸腺细胞球蛋白（ATG）是主要的治疗药物。由于前者产品的供应不足，在许多国家，马 ATG 已被兔 ATG 取代。本研究旨在评估这两种 ATG 制剂在 SAA 相关同胞 BMT 的预处理方案中是否可以互换。对 40 例连续 BMT 进行回顾性分析：20 例接受 Cy 加马 ATG 预处理，20 例接受 Cy 加兔 ATG 预处理。兔 ATG 预处理可预防急性移植物抗宿主病（aGVHD）Ⅱ-Ⅳ级和中重度慢性移植物抗宿主病（cGVHD），发生率分别为 0%对 35.2%（P =.009）和 0%对 34.0%（P =.04）。在第 100 天，兔 ATG 预处理组患者侵袭性真菌病（IFD）的确诊/可能发生率更高，分别为 31.2%和 5.5%（P =.04）。兔 ATG 预处理组更早出现巨细胞病毒（CMV）再激活（40 天与 50 天；P =.02）。兔 ATG 预处理组第 30 天（0.360 对 0.814×10(9)/L；P =.01）和第 90 天（0.744 对 1.330×10(9)/L；P =.006）的淋巴细胞计数较低。兔 ATG 预处理组稳定混合嵌合体的发生率较高（18.2%对 80%；P =.004）。这些结果表明，马和兔 ATG 制剂具有不同的生物学和临床特性，在 SAA 相关 BMT 的预处理方案中不应互换使用。
