Kekre Natasha, Zhang Ying, Zhang Mei-Jie, Carreras Jeanette, Ahmed Parvez, Anderlini Paolo, Atta Elias Hallack, Ayas Mouhab, Boelens Jaap Jan, Bonfim Carmem, Deeg H Joachim, Kapoor Neena, Lee Jong-Wook, Nakamura Ryotaro, Pulsipher Michael A, Eapen Mary, Antin Joseph H
Division of Hematology, The Ottawa Hospital, ON, Canada.
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
Haematologica. 2017 Jul;102(7):1291-1298. doi: 10.3324/haematol.2017.164459. Epub 2017 Mar 24.
For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% 6%, <0.001) and chronic (20% 9%, <0.001) graft--host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, =0.76, respectively. Among recipients of unrelated donor transplants, acute graft--host disease was also higher with horse compared to rabbit antithymocyte globulin (42% 23%, <0.001) but not chronic graft--host disease (38% 32%, =0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% 83%, =0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.
对于重型再生障碍性贫血的治疗，与兔抗胸腺细胞球蛋白相比，使用马抗胸腺细胞球蛋白进行免疫抑制治疗可产生更好的反应和更高的生存率。在移植情况下，这种相对优势可能有所不同，因为兔抗胸腺细胞球蛋白会导致更强的免疫抑制作用。我们分析了2008年至2013年间833例重型再生障碍性贫血移植病例，这些患者使用了人类白细胞抗原（HLA）匹配的同胞供者（n = 546）或无关供者（n = 287），他们在预处理方案和骨髓移植中接受了抗胸腺细胞球蛋白治疗。抗胸腺细胞球蛋白类型对造血恢复没有差异。在HLA匹配的同胞移植受者中，与兔抗胸腺细胞球蛋白相比，马抗胸腺细胞球蛋白组急性移植物抗宿主病（17%对6%，<0.001）和慢性移植物抗宿主病（20%对9%，<0.001）的100天发病率更高。3年总生存率没有差异，分别为87%和92%，P = 0.76。在无关供者移植受者中，与兔抗胸腺细胞球蛋白相比，马抗胸腺细胞球蛋白组急性移植物抗宿主病也更高（42%对23%，<0.001），但慢性移植物抗宿主病没有差异（38%对32%，P = 0.35）。无关供者移植后，马抗胸腺细胞球蛋白组的生存率较低，为75%对83%，P = 0.02。这些数据支持在重型再生障碍性贫血的骨髓移植预处理中使用兔抗胸腺细胞球蛋白。
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