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Graft-Versus-Host Disease

Pre-emptive therapy of acute graft-versus-host disease: a pilot study with antithymocyte globulin (ATG)

Bone Marrow Transplantation volume 28, pages 1093–1096 (2001)Cite this article

Abstract

We have previously shown that patients at high risk of graft-versus-host disease (GVHD) and transplant-related mortality (TRM) can be identified on day +7 following an allogeneic bone marrow transplant (BMT), based on serum bilirubin and blood urea nitrogen levels. One possible approach to reduce the risk of GVHD and TRM, is pre-emptive treatment with T cell antibodies. We report a pilot study testing the feasibility of this approach in 18 high risk patients, with a median age of 41, 83% of whom had advanced disease, undergoing an alternative donor BMT (family mismatched in five and unrelated in 13). The patients received three doses of rabbit antithymocyte globulin (ATG) (Thymoglobuline; Sangstat) 1.25 mg/kg on alternate days, starting at a median interval of 11 days (range 7–13) after BMT. Controls were 20 historical unrelated donor transplants (median age 35, 63% with advanced disease), with a high score from our original publication in 1999. The actuarial 1 year TRM of the ATG-treated patients was 40% compared to 60% for untreated controls (P = 0.06). Severe grade III–IV aGVHD developed in 27% of the ATG-treated patients, and in 55% of the controls (P = 0.08). This study indicates that early pre-emptive treatment of aGVHD in day +7 high risk patients is feasible and may lead to a reduction of aGVHD and TRM. This approach is being tested in a prospective randomized trial.

Bone Marrow Transplantation (2001) 28, 1093–1096.

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Acknowledgements

This work was supported by Associazione Italiana Ricerca contro il Cancro (AIRC) Milano grant to AB and Associazione Ricerca Trapianto Midollo Osseo (ARITMO) Genova. The great work of our nursing staff is gratefully acknowledged. The BMT transplant group from Hospital Gaslini, Genova Italy is also gratefully acknowledged.

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  1. Divisione Ematologia II, Ospedale San Martino, Genova, Italy

    A Bacigalupo, R Oneto, T Lamparelli, F Gualandi, S Bregante, AM Raiola, C Di Grazia, A Dominietto, C Romagnani, B Bruno, MT Van Lint & F Frassoni

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  1. A Bacigalupo
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  2. R Oneto
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  3. T Lamparelli
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  6. AM Raiola
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  8. A Dominietto
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  10. B Bruno
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Bacigalupo, A., Oneto, R., Lamparelli, T. et al. Pre-emptive therapy of acute graft-versus-host disease: a pilot study with antithymocyte globulin (ATG). Bone Marrow Transplant 28, 1093–1096 (2001). https://doi.org/10.1038/sj.bmt.1703306

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