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Beneficial impact of low-dose rabbit anti-thymocyte globulin in unrelated hematopoietic stem cell transplantation: focusing on difference between stem cell sources

Bone Marrow Transplantation volume 53, pages 634–639 (2018)Cite this article

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Recently, Lee SJ et al. [1] showed that unrelated bone marrow transplantation (uBMT) was favored because patients who underwent BMT had less long-term complications such as chronic graft-versus-host disease (GVHD) than those who underwent unrelated peripheral blood stem cell transplantation (uPBSCT). In order to prevent long-term complications, it is crucial to establish a strategy to effectively prevent severe chronic GVHD after PBSCT without compromising overall survival (OS).

Although anti-T lymphocyte globulin (ATG) might be an option to prevent chronic GVHD, there is still controversy regarding the benefit of ATG [2, 3]. The use of high ATG doses can lead to profound depletion of donor-derived T cells, which can increase the risk of viral infection and attenuate graft-vs.-leukemia effects. Since T-cell profiles vary significantly among stem cell sources, the optimal ATG dose might also differ. We previously reported that use of low-dose ATG-Thymoglobulin (ATG-T; median dose, 1.5 mg/kg) was associated with a lower incidence of severe/refractory chronic GVHD and superior GVHD-free, relapse-free survival (GRFS) in unrelated hematopoietic stem cell transplantation (HSCT), and 98% of patients received uBMT in this study [4].

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Acknowledgements

This work was supported by grants from the Japanese Ministry of Health, Labor and Welfare and the National Cancer Research and Development Fund (29-A-14) and in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation #17ek0510014h0001) from Japan Agency for Medical Research and Development, AMED. We thank the medical, nursing, data-processing, laboratory and clinical staff members at the participating centers for their important contributions to this study and their dedicated patient care.

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Authors and Affiliations

  1. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan

    Takafumi Shichijo, Shigeo Fuji, Kinuko Tajima, Hiroyuki Kubo, Kenji Nozaki, Tadahiro Honda, Junko Yamaguchi, Ichiro Kawashima, Akihisa Kawajiri, Tomonari Takemura, Akio Onishi, Ayumu Ito, Takashi Tanaka, Yoshihiro Inamoto, Saiko Kurosawa, Sung-Won Kim & Takahiro Fukuda

  2. Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto, Japan

    Takafumi Shichijo

  3. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Shigeo Fuji

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Correspondence to Shigeo Fuji.

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Shichijo, T., Fuji, S., Tajima, K. et al. Beneficial impact of low-dose rabbit anti-thymocyte globulin in unrelated hematopoietic stem cell transplantation: focusing on difference between stem cell sources. Bone Marrow Transplant 53, 634–639 (2018). https://doi.org/10.1038/s41409-017-0045-9

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