Yang Xue, Li Dongjun, Xie Yao
Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
Front Oncol. 2021 Aug 20;11:717678. doi: 10.3389/fonc.2021.717678. eCollection 2021.
Anti-thymocyte globulin (ATG) prophylaxis reduces graft--host disease (GVHD) incidence. This meta-analysis aimed to explore the long-term efficacy of ATG and the influencing factors in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
PubMed, Embase, and Cochrane databases were searched for the relevant studies published up to August 2020. Data from randomized controlled trials (RCTs) on ATG prophylaxis for GVHD prevention in allo-HSCT patients were extracted.
A total of eight relevant RCTs (1,348 patients) were included. ATG significantly reduced the incidence of grade III-IV aGVHD (P = 0.001) and cGVHD (P < 0.001). ATG significantly improved the GVHD relapse-free survival (GRFS) (P < 0.001). The immunosuppressive regimen (number and dose of immunosuppressants) was significantly reduced when using ATG (P = 0.005). Epstein-Barr virus (EBV) reactivation was high in patients receiving ATG (P = 0.003). No significant differences were detected in relapses, overall survival (OS), relapse-free survival (RFS), and non-relapse mortality (NRM) between the ATG and no ATG groups. Subgroup analyses revealed that the donor type and ATG formulation might be the possible sources of heterogeneity among the included studies. Meta-regression analysis showed that the cumulative dose of ATG did not affect GVHD, OS, relapse, RFS, and NRM.
Although ATG had no significant effect on relapse, RFS, and NRM, it significantly reduced the occurrence and severity of GVHD, improved the GRFS, and reduced the number and dose of immunosuppressants in patients undergoing allo-HSCT.
抗胸腺细胞球蛋白（ATG）预防可降低移植物抗宿主病（GVHD）的发生率。本荟萃分析旨在探讨ATG在接受异基因造血干细胞移植（allo-HSCT）患者中的长期疗效及影响因素。
检索PubMed、Embase和Cochrane数据库，查找截至2020年8月发表的相关研究。提取关于ATG预防allo-HSCT患者GVHD的随机对照试验（RCT）数据。
共纳入8项相关RCT（1348例患者）。ATG显著降低了III-IV级急性GVHD（P = 0.001）和慢性GVHD（P < 0.001）的发生率。ATG显著改善了无GVHD复发生存期（GRFS）（P < 0.001）。使用ATG时，免疫抑制方案（免疫抑制剂的数量和剂量）显著减少（P = 0.005）。接受ATG的患者中，爱泼斯坦-巴尔病毒（EBV）再激活率较高（P = 0.003）。ATG组和非ATG组在复发、总生存期（OS）、无复发生存期（RFS）和非复发死亡率（NRM）方面未检测到显著差异。亚组分析显示，供体类型和ATG制剂可能是纳入研究中异质性的可能来源。Meta回归分析表明，ATG的累积剂量不影响GVHD、OS、复发、RFS和NRM。
尽管ATG对复发、RFS和NRM无显著影响，但它显著降低了allo-HSCT患者GVHD的发生率和严重程度，改善了GRFS，并减少了免疫抑制剂的数量和剂量。
