Graduate Program in Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
PLoS One. 2023 Apr 18;18(4):e0284476. doi: 10.1371/journal.pone.0284476. eCollection 2023.
Rabbit anti-thymocyte globulin (ATG) has been used in allogeneic hematopoietic stem cell transplantation (Allo-HSCT) for graft-versus-host disease (GvHD) prophylaxis. Since the best dose has not been defined yet, this study aimed to determine the efficacy and safety of different doses of ATG in Allo-HSCT. Data sources were MEDLINE/PUBMED, EMBASE, Cochrane Library, Web of Science, LILACS, and SciELO. Studies were eligible when comparing doses of ATG. The higher dose was in the intervention group. A total of 22 articles (2002-2022) were included. Higher doses (4-12 mg/kg) of ATG-T reduced the incidence of grade III-IV acute GvHD (RR 0.60; 95%CI 0.42-0.84) and limited chronic GvHD (RR 0.64 95%CI 0.45-0.92) compared with lower doses (2-7.5 mg/kg). Higher doses increased the Epstein-Barr virus (RR 1.90 95% CI 1.49-2.42) and Cytomegalovirus reactivation (RR, 1.30; 95% CI 1.03-1.64). Relapse rates were higher in the higher dose group (RR 1.34, 95% CI 1.07-167). The ATG-T dose ≥7mg/kg versus the lower dose showed a number needed to treat 7.4 for acute GvHD III-IV, with a number to harm of 7.7 for relapse at one year in the higher dose group. A dose lower than 7 mg/kg suggests a better risk-benefit ratio than a higher one. Well-designed RCT is needed to define the best risk-benefit doses. Trial registration: Trial registration number: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020173449.
兔抗胸腺细胞球蛋白（ATG）已用于异基因造血干细胞移植（Allo-HSCT）以预防移植物抗宿主病（GvHD）。由于尚未确定最佳剂量，本研究旨在确定 Allo-HSCT 中不同剂量 ATG 的疗效和安全性。数据来源为 MEDLINE/PUBMED、EMBASE、Cochrane 图书馆、Web of Science、LILACS 和 SciELO。当比较 ATG 剂量时，研究符合入选标准。较高剂量在干预组。共纳入 22 篇文章（2002-2022 年）。与低剂量（2-7.5mg/kg）相比，高剂量（4-12mg/kg）的 ATG-T 降低了 III-IV 级急性 GvHD 的发生率（RR 0.60；95%CI 0.42-0.84）和局限性慢性 GvHD（RR 0.64 95%CI 0.45-0.92）。高剂量增加了 Epstein-Barr 病毒（RR 1.90 95%CI 1.49-2.42）和巨细胞病毒再激活（RR，1.30；95%CI 1.03-1.64）。高剂量组的复发率更高（RR 1.34，95%CI 1.07-167）。ATG-T 剂量≥7mg/kg 与低剂量相比，急性 GvHD III-IV 的治疗人数需要 7.4 人，高剂量组一年时复发的危害人数为 7.7 人。低于 7mg/kg 的剂量表明风险收益比优于高剂量。需要进行精心设计的 RCT 来确定最佳风险收益剂量。试验注册：试验注册号：PROSPERO：https://www.crd.york.ac.uk/prospero/display_record.php？ID=CRD42020173449。
