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Graft-Versus-Host Disease

Treatment of steroid-resistant acute graft-versus-host disease with anti-thymocyte globulin

Bone Marrow Transplantation volume 27, pages 1059–1064 (2001)Cite this article

Abstract

Acute graft-versus-host disease (aGVHD) is a major cause of mortality after allogeneic stem cell transplantation. Although initial treatment with corticosteroids is effective in the majority of patients, 30–60% develop steroid resistance. Anti-thymocyte globulin (ATG) is commonly used as first-line therapy for steroid resistant (SR) aGVHD. However, data on its efficacy are limited. At two institutions we reviewed the results of treatment with ATG of 58 patients with SR aGVHD. Initial manifestations of aGVHD were treated with 2 mg/kg/day of methylprednisolone (MP). Equine ATG was administered as first-line therapy for SR aGVHD, a median of 9 days (range, 3 to 39) after initiation of MP. At the time of initiation of ATG, IBMTR severity indices B, C and D were observed in 6%, 40% and 54% of patients, respectively. Improvement was observed in 30% of patients treated with ATG. Skin disease was more likely to improve with ATG (79%), while progression of gut and liver aGVHD was observed in 40% and 66% of patients, respectively. Despite initial improvement, 52 patients (90%) died a median of 40 days after ATG therapy from progressive aGVHD and/or infection (74%), ARDS (15%), or relapse (11%). Only six patients (10%), three of whom had aGVHD limited to the skin at the time ATG was administered, are long-term survivors. We conclude that initial improvement of SR aGVHD occurs with ATG in a minority of patients, and very few patients become long-term survivors. Furthermore, this treatment is associated with a high rate of major complications. Bone Marrow Transplantation (2001) 27, 1059–1064.

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Acknowledgements

We thank the physicians, nurses and staff at the Washington University (St Louis, MO) and City of Hope (Duarte, CA) who cared for the patients. We especially thank Carla Brewster and Kim Gilfillan for excellent data retrieval. We also thank Dr Philip Rowlings for providing survival estimates from the IBMTR database. We thank Mrs Ruby Morrissey for secretarial support in the preparation of this manuscript. This work was supported by NCI PPG CA 30206 and NCI CA 33572.

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  1. Department of Medicine, Division of Bone Marrow Transplantation and Stem Cell Biology, Washington University School of Medicine, St Louis, MO, USA

    H Khoury, DR Adkins, RA Brown, G Miller, R Vij, P Westervelt, K Trinkaus, LT Goodnough & JF DiPersio

  2. Division of Hematology and Bone Marrow Transplantation, City of Hope National Medical Center, Duarte, CA, USA

    A Kashyap, P Parker & SJ Forman

  3. Department of Pediatrics, Division of Hematology Oncology, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA

    RJ Hayashi

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Khoury, H., Kashyap, A., Adkins, D. et al. Treatment of steroid-resistant acute graft-versus-host disease with anti-thymocyte globulin. Bone Marrow Transplant 27, 1059–1064 (2001). https://doi.org/10.1038/sj.bmt.1703032

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