Antithymocyte globulin (ATG) is an important component of conditioning regimens to prevent graft-versus-host disease (GVHD) in unrelated hematopoietic stem cell transplantation (HSCT), but the optimal dose of ATG remains unknown. We prospectively analyzed 205 unrelated HSCTs in patients with malignant hematological disorders. HSCTs were classified as follows: HLA-matched transplant without ATG (n = 53, group A), HLA-mismatched transplant treated with 6.0 mg/kg thymoglobulin (n = 77, group B), and HLA-matched transplant treated with 4.5 mg/kg thymoglobulin (n = 75, group C). For groups A and B, the 5-year moderate/severe chronic GVHD rates were 31.9% and 24.2%, the 5-year GVHD-free and relapse-free survival (GRFS) rates were 28.3 and 47%, and the 2-year immunosuppressive therapy (IST)-free survival rates were 8.6% and 40.2% (p = 0.0016), respectively. Furthermore, group C had lower incidences of grade II-IV acute GVHD (18.7%) and 5-year moderate/severe chronic GVHD (16.6%) than group A did. Group C had higher 5-year GRFS (52.1% vs 28.3%, p = 0.002), 2-year IST-free survival (51.7% vs 8.6%, p = 0.00004), and 5-year overall survival (OS) (68.3% vs 41.5%, p = 0.007) rates than group A did. Thus, ATG was associated with better GVHD prevention, a higher rate of IST-free survival, lower transplant-related mortality (TRM), and superior OS and GRFS in unrelated HSCTs.
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This work was supported by the National Natural Science Foundation of China (NSFC; 81730008), the National Natural Science Foundation of China (NSFC; 81670169), and the Zhejiang Key Research and Development Program (2015C03038). The funders did not influence how the research was conducted or the approval of the manuscript. We thank all patients and transplantation staff.
Conflict of interest
The authors declare that they have no conflict of interest.
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