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Efficacy of low dose antithymocyte globulin on overall survival, relapse rate, and infectious complications following allogeneic peripheral blood stem cell transplantation for leukemia in children

Bone Marrow Transplantation volume 56, pages 890–899 (2021)Cite this article

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Abstract

Antithymocyte globulin (ATG) and anti-T lymphocyte globulin (ATLG) have been widely used to prevent graft-versus-host disease (GvHD), each with distinct properties and noninterchangeable doses. However, the optimal dose of ATG in children undergoing allo-PBSCT for leukemia has not yet been established. Therefore, the impact of ATG dose on overall survival (OS), relapse, GvHD, and infectious complications was investigated. Patients administered high dose (unrelated: 7.5 mg/kg, haploidentical: 10.0 mg/kg) and low dose (unrelated: 3.75 mg/kg, haploidentical: 5.0 mg/kg) ATG during two consecutive time periods were compared. There were 78 (39.8%) patients in the low dose group and 118 (60.2%) in the high dose group. OS was superior in the low dose group compared to the high dose group (P = 0.017), and relapse incidence was significantly lower in the low dose group (P = 0.022). Cumulative incidences of acute and chronic GvHD were similar between the groups (P = 0.095 and P = 0.672, respectively). Cytomegalovirus reactivation (70.3% vs. 51.3%, P = 0.007), Epstein–Barr virus reactivation (81.4% vs. 39.7%, P < 0.001), and invasive bacterial infections (12.7% vs. 0%, P = 0.001) post transplant were more frequent in the high dose group compared to the low dose group. Therefore, low dose ATG is more optimal in pediatric allo-PBSCT providing better OS while lowering the risk of relapse and infectious complications.

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Fig. 1: Flow chart of patients included and excluded in this study.
Fig. 2: Survival outcomes of patients by ATG dose group.
Fig. 3: Relapse incidence and non-relapse mortality by ATG dose group.
Fig. 4: Immune reconstitution by ATG dose group.

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  1. These authors contributed equally: Hyun Mi Kang, Seong Koo Kim

Authors and Affiliations

  1. Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Hyun Mi Kang, Seong Koo Kim, Jae Wook Lee, Nack-Gyun Chung & Bin Cho

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  1. Hyun Mi Kang
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Correspondence to Bin Cho.

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Kang, H.M., Kim, S.K., Lee, J.W. et al. Efficacy of low dose antithymocyte globulin on overall survival, relapse rate, and infectious complications following allogeneic peripheral blood stem cell transplantation for leukemia in children. Bone Marrow Transplant 56, 890–899 (2021). https://doi.org/10.1038/s41409-020-01121-9

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