Effect of Antithymocyte Globulin Source on Outcomes of Bone Marrow Transplantation for Severe Aplastic Anemia

Overview

Journal Haematologica

Specialty Hematology

Date 2017 Mar 26

PMID 28341733

Citations 18

Authors

Natasha Kekre

Ying Zhang

Mei-Jie Zhang

Jeanette Carreras

Parvez Ahmed

Paolo Anderlini

Elias Hallack Atta

Mouhab Ayas

Jaap Jan Boelens

Carmem Bonfim

H Joachim Deeg

Neena Kapoor

Jong-Wook Lee

Ryotaro Nakamura

Michael A Pulsipher

Mary Eapen

Joseph H Antin

Affiliations

Soon will be listed here.

Abstract

For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% 6%, <0.001) and chronic (20% 9%, <0.001) graft--host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, =0.76, respectively. Among recipients of unrelated donor transplants, acute graft--host disease was also higher with horse compared to rabbit antithymocyte globulin (42% 23%, <0.001) but not chronic graft--host disease (38% 32%, =0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% 83%, =0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.

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