Takeuchi Yuki, Miyao Kotaro, Negishi Shuto, Ohara Fumiya, Motegi Kenta, Wakabayashi Hiroya, Yokota Hirofumi, Kuwano Shihomi, Sawa Hitomi, Inagaki Yuichiro, Sawa Masashi
Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan.
Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan.
Transplant Cell Ther. 2023 May;29(5):325.e1-325.e10. doi: 10.1016/j.jtct.2023.01.026. Epub 2023 Feb 2.
Graft-versus-host disease (GVHD) is a major complication of allogeneic peripheral blood stem cell transplantation (PBSCT). Previous randomized studies have already shown that the use of several types of antihuman T lymphocyte immune globulin (ATG) as GVHD prophylaxis can reduce the incidence of acute GVHD and chronic GVHD. However, the efficacy and safety of PBSCT from HLA-identical donors with low-dose ATG remain unclear. This study aimed to clarify the efficacy and safety of PBSCT from HLA-identical donors with low-dose ATG compared with PBSCT from HLA-identical donors without ATG. To do so, we retrospectively analyzed the outcomes of patients who underwent allogeneic PBSCT from HLA-identical donors with low-dose ATG-thymoglobulin (ATG-T; 2.5 mg/kg) versus those who did not receive ATG-T. Patient data were collected retrospectively from the medical records of Anjo Kosei Hospital. This study was conducted from 2009 to the final follow-up in October 2022. Forty-seven of 91 patients received ATG-T between January 2009 and March 2020. ATG-T reduced the incidence rates of moderate-to-severe chronic GVHD (hazard ratio [HR], .15; 95% confidence interval [CI], .057 to .41; P < .0010) and nonrelapse mortality (HR, .21; 95% CI, .0058 to.75, P = .016) without increasing the risk of relapse. Overall survival did not differ significantly between the 2 groups; however, the low-dose ATG-T group had better moderate-to-severe chronic GVHD-free, relapse-free survival rates (HR, .47; 95% CI, .27 to .80, P = .0054) than the non-ATG-T group. In addition, multistate analysis revealed that the low-dose ATG-T group had better current GVHD-free, relapse-free survival at 24 months after transplantation (45% [95% CI, 29% to 63%)] versus 21% [95% CI, 9.1% to 34%]; P = .015). Low-dose ATG-T was not associated with increased incidence of infections or adverse events. Our findings suggest that low-dose ATG-T can be beneficial for patients receiving PBSCT from HLA-identical donors. © 2023 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
移植物抗宿主病（GVHD）是异基因外周血干细胞移植（PBSCT）的主要并发症。既往随机研究已表明，使用几种类型的抗人T淋巴细胞免疫球蛋白（ATG）作为GVHD预防措施可降低急性GVHD和慢性GVHD的发生率。然而，低剂量ATG用于 HLA 全相合供者的 PBSCT 的疗效和安全性仍不明确。本研究旨在阐明与未使用ATG的 HLA 全相合供者的 PBSCT 相比，低剂量ATG用于 HLA 全相合供者的 PBSCT 的疗效和安全性。为此，我们回顾性分析了接受低剂量兔抗人胸腺细胞球蛋白（ATG-T；2.5 mg/kg）的 HLA 全相合供者的异基因 PBSCT 患者与未接受ATG-T患者的结局。患者数据从安城厚生医院的病历中回顾性收集。本研究于2009年开展至2022年10月的最终随访。91例患者中有47例在2009年1月至2020年3月期间接受了ATG-T。ATG-T降低了中重度慢性GVHD的发生率（风险比[HR]，0.15；95%置信区间[CI]，0.057至0.41；P <0.0010）和非复发死亡率（HR，0.21；95%CI，0.0058至0.75，P =0.016），且未增加复发风险。两组的总生存率无显著差异；然而，低剂量ATG-T组的中重度慢性GVHD-free、无复发生存率（HR，0.47；95%CI，0.27至0.80，P =0.0054）优于非ATG-T组。此外，多状态分析显示，低剂量ATG-T组在移植后24个月时的当前GVHD-free、无复发生存率更好（分别为45%[95%CI，29%至63%]和21%[95%CI，9.1%至34%]；P =0.015）。低剂量ATG-T与感染或不良事件发生率增加无关。我们的研究结果表明，低剂量ATG-T对接受 HLA 全相合供者的 PBSCT 的患者可能有益。©2023美国移植与细胞治疗学会。由爱思唯尔公司出版。
