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Anti-Thymocyte Globulin

Reduced incidence of GVHD without increase in relapse with low-dose rabbit ATG in the preparative regimen for unrelated bone marrow transplants in CML

Bone Marrow Transplantation volume 32, pages 237–242 (2003)Cite this article

Summary:

Antithymocyte globulin (ATG) treatment prevents graft failure and results in a low incidence of GVHD, but an increased risk of relapse could be expected as a consequence of reduced GVHD. From September 1995 to June 2001, 28 consecutive chronic myeloid leukemia (CML) patients underwent unrelated bone marrow transplants: 21 were in chronic phase (CP) and seven in advanced phase (AP). Median age was 35.5 years (range 20–50). HLA typing was based on high-resolution molecular techniques; in eight cases there were one or more allele mismatches. The preparative regimen consisted of TBI, EDX 120 mg/kg and rabbit ATG 15 mg/kg. All patients engrafted and no rejection occurred. Acute GVHD grade III–IV occurred in six patients (21%). Chronic GVHD occurred in 10 (40%) and it was extensive in one. Four out of seven patients transplanted in AP had a hematological relapse. Of 21 in CP, there was one cytogenetic and one molecular relapse: these two patients are now in complete remission with imatinib mesylate. With a median follow-up of 45.7 months, the 5-year survival is 76.2% for those transplanted in CP. These data demonstrate that transplants performed in CP, with low-dose ATG, are associated with a good outcome, low incidence of GVHD and no increase of relapse.

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Acknowledgements

The technical assistance of Mrs Manuela Bernardi is kindly appreciated.

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Authors and Affiliations

  1. Institute of Hematology and Clinical Oncology ‘L e A. Seràgnoli’, University of Bologna, St Orsola Hospital, Bologna, Italy

    F Bonifazi, G Bandini, D Rondelli, S Falcioni, M Stanzani, M Arpinati, B Giannini & M Baccarani

  2. Tissue Typing Regional Reference Center, St Orsola Hospital, Bologna, Italy

    A Bontadini, P L Tazzari & R Conte

  3. Stem Cell Transplant Program, Section of Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA

    D Rondelli

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Bonifazi, F., Bandini, G., Rondelli, D. et al. Reduced incidence of GVHD without increase in relapse with low-dose rabbit ATG in the preparative regimen for unrelated bone marrow transplants in CML. Bone Marrow Transplant 32, 237–242 (2003). https://doi.org/10.1038/sj.bmt.1704138

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