Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Bone Marrow Transplant. 2021 Apr;56(4):890-899. doi: 10.1038/s41409-020-01121-9. Epub 2020 Nov 17.
Antithymocyte globulin (ATG) and anti-T lymphocyte globulin (ATLG) have been widely used to prevent graft-versus-host disease (GvHD), each with distinct properties and noninterchangeable doses. However, the optimal dose of ATG in children undergoing allo-PBSCT for leukemia has not yet been established. Therefore, the impact of ATG dose on overall survival (OS), relapse, GvHD, and infectious complications was investigated. Patients administered high dose (unrelated: 7.5 mg/kg, haploidentical: 10.0 mg/kg) and low dose (unrelated: 3.75 mg/kg, haploidentical: 5.0 mg/kg) ATG during two consecutive time periods were compared. There were 78 (39.8%) patients in the low dose group and 118 (60.2%) in the high dose group. OS was superior in the low dose group compared to the high dose group (P = 0.017), and relapse incidence was significantly lower in the low dose group (P = 0.022). Cumulative incidences of acute and chronic GvHD were similar between the groups (P = 0.095 and P = 0.672, respectively). Cytomegalovirus reactivation (70.3% vs. 51.3%, P = 0.007), Epstein-Barr virus reactivation (81.4% vs. 39.7%, P < 0.001), and invasive bacterial infections (12.7% vs. 0%, P = 0.001) post transplant were more frequent in the high dose group compared to the low dose group. Therefore, low dose ATG is more optimal in pediatric allo-PBSCT providing better OS while lowering the risk of relapse and infectious complications.
抗胸腺细胞球蛋白（ATG）和抗 T 淋巴细胞球蛋白（ATLG）已广泛用于预防移植物抗宿主病（GvHD），它们具有不同的特性和不可互换的剂量。然而，儿童接受异体 PBSCT 治疗白血病时，ATG 的最佳剂量尚未确定。因此，研究了 ATG 剂量对总生存率（OS）、复发、GvHD 和感染并发症的影响。在两个连续时间段内，接受高剂量（无关供体：7.5mg/kg，半相合：10.0mg/kg）和低剂量（无关供体：3.75mg/kg，半相合：5.0mg/kg）ATG 的患者进行了比较。低剂量组有 78 例（39.8%）患者，高剂量组有 118 例（60.2%）患者。与高剂量组相比，低剂量组的 OS 更优（P=0.017），且低剂量组的复发率显著降低（P=0.022）。两组间急性和慢性 GvHD 的累积发生率相似（P=0.095 和 P=0.672）。高剂量组移植后巨细胞病毒再激活（70.3% vs. 51.3%，P=0.007）、EB 病毒再激活（81.4% vs. 39.7%，P<0.001）和侵袭性细菌感染（12.7% vs. 0%，P=0.001）更为频繁。因此，低剂量 ATG 更适用于儿科 allo-PBSCT，可提供更好的 OS，同时降低复发和感染并发症的风险。
