Grasso Antonio Giacomo, Simeone Roberto, Maestro Alessandra, Zanon Davide, Maximova Natalia
Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy.
Department of Transfusion Medicine, ASUGI, Piazza dell'Ospitale 1, 34125 Trieste, Italy.
J Clin Med. 2023 Jan 16;12(2):730. doi: 10.3390/jcm12020730.
The use of anti-thymocyte globulin (ATG) as part of conditioning to prevent graft-versus-host disease (GVHD) may severely impair immune reconstitution (IR). We analyzed relationships between ATG exposure, the recipient lymphocyte count, IR, and transplant outcome. We retrospectively reviewed patients aged ≤ 18 years who underwent allogeneic HSCT between April 2005 and April 2020. The outcomes of interest included the incidence of GVHD, overall survival (OS), and IR. IR was analyzed through thymic magnetic resonance imaging (MRI) and by quantifying T CD4+ and recent thymic emigrants (RTEs). The ATG-exposed group was split into a low ATG/lymphocyte ratio subgroup (ratio < 0.01) and a high ATG/lymphocyte ratio subgroup (ratio > 0.01). The low ratio subgroup had a higher incidence of GVHD (29 [59%] vs. 7 [16.6%]) but a better IR in both laboratory and MRI imaging assessments (p < 0.0001). The median thymic volume in the low ratio subgroup was significantly higher (14.7 cm3 vs. 4.5 cm3, p < 0.001). This was associated with a better OS and lower transplant-related mortality (TRM) (80.4% vs. 58.0%, p = 0.031) and (13.1% vs. 33.0%, p = 0.035). An individualized approach to ATG dosing allows for the obtainment of rapid thymic reconstitution and the best transplant-related outcomes.
使用抗胸腺细胞球蛋白（ATG）作为预处理的一部分以预防移植物抗宿主病（GVHD）可能会严重损害免疫重建（IR）。我们分析了ATG暴露、受体淋巴细胞计数、IR和移植结果之间的关系。我们回顾性分析了2005年4月至2020年4月期间接受异基因造血干细胞移植（HSCT）的18岁及以下患者。感兴趣的结果包括GVHD的发生率、总生存期（OS）和IR。通过胸腺磁共振成像（MRI）以及定量T CD4 +和近期胸腺迁出细胞（RTE）来分析IR。将ATG暴露组分为低ATG/淋巴细胞比率亚组（比率<0.01）和高ATG/淋巴细胞比率亚组（比率>0.01）。低比率亚组的GVHD发生率更高（29例[59%]对7例[16.6%]），但在实验室和MRI成像评估中IR均更好（p<0.0001）。低比率亚组的胸腺中位体积显著更高（14.7 cm³对4.5 cm³，p<0.001）。这与更好的OS和更低的移植相关死亡率（TRM）相关（80.4%对58.0%，p = 0.031）以及（13.1%对33.0%，p = 0.035）。采用个体化的ATG给药方法能够实现快速的胸腺重建以及最佳的移植相关结果。
