Chen Juan, Zhang Yuanfeng, Chen Xin, Pang Aiming, Zhao Yuanqi, Liu Li, Ma Runzhi, Wei Jialin, He Yi, Yang Donglin, Zhang Rongli, Zhai Weihua, Ma Qiaoling, Jiang Erlie, Han Mingzhe, Zhou Jiaxi, Feng Sizhou
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Heping District, Tianjin, 300020, China.
Department of Hematology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, 264000, Shandong Province, China.
Cancer Cell Int. 2022 Feb 21;22(1):89. doi: 10.1186/s12935-021-02410-z.
To evaluate the efficacy and safety of P-ALG (porcine anti-lymphocyte globulin) and R-ATG (rabbit anti-thymocyte globulin) in the conditioning regime for patients with acquired aplastic anemia who underwent HLA-haploidentical hematopoietic stem cell transplantation (halpo-HSCT).
A total of 91 patients with acquired aplastic anemia who received haplo-HSCT at our center between January 2014 and December 2020 were retrospectively reviewed. Twenty-eight patients were in the P-ALG group while sixty-three patients were in the R-ATG group.
The median time was 11 versus 13 days (P = 0.294) for myeloid engraftment and 12.5 versus 15 days (P = 0.465) for platelet engraftment in the P-ALG and R-ATG groups, respectively. There were no significant difference in 5-year overall survival (74.83% ± 8.24% vs 72.29% ± 6.26%, P = 0.830), GVHD-free, failure-free survival (71.05% ± 8.65% vs 62.71% ± 6.22%, P = 0.662), failure-free survival (74.83% ± 8.24% vs 66.09% ± 5.84%, P = 0.647) and transplantation-related mortality (25.17% ± 8.24% vs 26.29% ± 6.22%, P = 0.708) between the two groups. The incidence of aGVHD (acute graft versus host disease) (65.39% ± 9.33% vs 62.71% ± 6.30%, P = 0.653), II-IV aGVHD (38.46% ± 9.54% vs 35.64% ± 6.24%, P = 0.695), III-IV aGVHD (19.23% ± 7.73% vs 10.53% ± 4.07%, P = 0.291), cGVHD (chronic graft versus host disease) (22.22% ± 12.25% vs 22.31% ± 6.30%, P = 0.915), and moderate to severe cGVHD (5.56% ± 5.40% vs 9.28% ± 4.46%, P = 0.993) were not significantly different. Similar outcomes were observed between the P-ALG and R-ATG groups for severe bacterial infection (17.9% vs 25.4%, P = 0.431), invasive fungal diseases (3.6% vs 9.5%, P = 0.577) and graft rejection (0% vs 9.5%, P = 0.218). However, the incidence of cytomegalovirus infection and Epstein-Barr virus infection was significantly lower in the P-ALG group (46.4% vs 71.4%, P = 0.022; 3.6% vs 25.4%, P = 0.014).
The efficacy and safety of P-ALG were similar with R-ATG in the setting of haplo-HSCT for patients with acquired aplastic anemia patients. P-ALG could be an alternative for R-ATG.
评估猪抗淋巴细胞球蛋白（P-ALG）和兔抗胸腺细胞球蛋白（R-ATG）在接受人类白细胞抗原半相合造血干细胞移植（halpo-HSCT）的获得性再生障碍性贫血患者预处理方案中的疗效和安全性。
回顾性分析2014年1月至2020年12月在本中心接受半相合HSCT的91例获得性再生障碍性贫血患者。28例患者为P-ALG组，63例患者为R-ATG组。
P-ALG组和R-ATG组的髓系植入中位时间分别为11天和13天（P = 0.294），血小板植入中位时间分别为12.5天和15天（P = 0.465）。两组的5年总生存率（74.83%±8.24% vs 72.29%±6.26%，P = 0.830）、无移植物抗宿主病（GVHD）无失败生存率（71.05%±8.65% vs 62.71%±6.22%，P = 0.662）、无失败生存率（74.83%±8.24% vs 66.09%±5.84%，P = 0.647）和移植相关死亡率（25.17%±8.24% vs 26.29%±6.22%，P = 0.708）无显著差异。急性移植物抗宿主病（aGVHD）发生率（65.39%±9.33% vs 62.71%±6.30%，P = 0.653）、II-IV级aGVHD发生率（38.46%±9.54% vs 35.64%±6.24%，P = 0.695）、III-IV级aGVHD发生率（19.23%±7.73% vs 10.53%±4.07%，P = 0.291）、慢性移植物抗宿主病（cGVHD）发生率（22.22%±12.25% vs 22.31%±6.30%，P = 0.915）以及中度至重度cGVHD发生率（5.56%±5.40% vs 9.28%±4.46%，P = 0.993）无显著差异。P-ALG组和R-ATG组在严重细菌感染（17.9% vs 25.4%，P = 0.431）、侵袭性真菌病（3.6% vs 9.5%，P = 0.577）和移植物排斥反应（0% vs 9.5%，P = 0.218）方面观察到相似的结果。然而，P-ALG组的巨细胞病毒感染和EB病毒感染发生率显著较低（46.4% vs 71.4%，P = 0.022；3.6% vs 25.4%，P = 0.014）。
在获得性再生障碍性贫血患者的半相合HSCT中，P-ALG的疗效和安全性与R-ATG相似。P-ALG可作为R-ATG的替代药物。
