1. ¹Department of Pediatric Hematology and Oncology, University Hospital Motol, Charles University Prague, Prague, Czech Republic
2. ²Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University Prague, Prague, Czech Republic

Correspondence: Dr P Sedláek, Department of Pediatric Hematology and Oncology, University Hospital Motol, Charles University Prague, V Uvalu 84, Prague 15006, Czech Republic. E-mail: petr.sedlacek@lfmotol.cuni.cz

Received 30 May 2006; Revised 15 September 2006; Accepted 18 September 2006; Published online 16 October 2006.

Abstract

Human leukocyte antigen (HLA)-matched sibling donor hematopoietic stem cell transplantation (HSCT) is available for only approximately 30% patients needing HSCT. Use of alternative donors is associated with a high incidence and severity of graft-versus-host disease (GVHD). Here we report our experience with GVHD prophylaxis using pre-transplant rabbit antithymocyte globulin (rATG), in addition to post transplant cyclosporin A and methotrexate. Seventy-five children received unmanipulated grafts from 7 to 10/10 HLA allele-matched unrelated donors. Median follow-up was 25 months (range, 6–65 months). Only 2/75 patients (2.5%) developed acute GVHD grades III–IV, and 17/75 (25%) developed extensive chronic GVHD. Overall survival was 79%. It was similar in patients receiving grafts from 7 or 8/10 to 9 or 10/10 allele-matched donors, and similar in patients receiving peripheral blood stem cells and marrow. Six (11%) patients died owing to relapse, and 10 (13%) due to transplant-related complications. The addition of rATG appears to result in a low incidence of severe GVHD and overall mortality.