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Use of anti-thymocyte globulin (ATG) for the treatment of pure red cell aplasia and immune-mediated cytopenias after allogeneic hematopoietic cell transplantation: a case series

Bone Marrow Transplantation volume 55, pages 2326–2330 (2020)Cite this article

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Immune-mediated cytopenias seen after allogeneic hematopoietic cell transplantation (allo-HCT) can be severe and refractory to standard therapy [1]. These cytopenias can result from antibodies against donor cells and may often respond to immunosuppression targeting antibody-producing B cells. However, in refractory cases, T-cell directed therapies, such as anti-thymocyte globulin (ATG), have been reported in single-patient case reports [2, 3]. This study aims to report our experience using ATG for the treatment of posttransplant immune cytopenias.

This is a single-center, retrospective study at Memorial Sloan Kettering Cancer Center (MSKCC) approved under a MSKCC IRB waiver. We included all patients who underwent their first matched- related or unrelated allo-HCT at MSKCC between 2008 and 2018 and received ATG post-HCT for the treatment of cytopenia(s). Patients who received ATG as part of a second conditioning regimen and/or with a concomitant hematopoietic progenitor cell infusion were excluded.

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Fig. 1: Five patients with pure red cell aplasia (PRCA).

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Acknowledgements

We thank the clinical research staff, nurses, advanced practice providers, and physicians of the Adult Bone Marrow Transplant Service at MSKCC for assistance with patient clinical care and data collection.

Funding

This research was supported in part by National Institutes of Health Grant P01 CA23766 and National Cancer Institute Cancer Center Support Grant P30 CA008748. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Alexandra Gomez-Arteaga, Michael Scordo, Roni Tamari, Josel D. Ruiz, Ann A. Jakubowski, Esperanza B. Papadopoulos, Sergio A. Giralt, Miguel-Angel Perales, Hugo R. Castro-Malaspina, Craig S. Sauter & Parastoo B. Dahi

  2. Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Michael Scordo, Roni Tamari, Ann A. Jakubowski, Esperanza B. Papadopoulos, Sergio A. Giralt, Miguel-Angel Perales, Hugo R. Castro-Malaspina, Craig S. Sauter & Parastoo B. Dahi

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  1. Alexandra Gomez-Arteaga
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Correspondence to Parastoo B. Dahi.

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Conflict of interest

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests—PBD: Serves on the scientific advisory board of Kite—A Gilead Company. SAG: Consultancy for Amgen, Actinium, Celgene, Johnson & Johnson, Takeda, Jazz Pharmaceuticals, Novartis, Kite, Spectrum Pharmaceuticals. Research support for clinical trials from Amgen, Actinium, Celgene, Johnson & Johnson, Takeda, and Miltenyi. MAP: Honoraria from Abbvie, Bellicum, Bristol-Myers Squibb, Incyte, Merck, Novartis, Nektar Therapeutics, and Takeda. He serves on DSMBs for Servier and Medigene, and the scientific advisory boards of MolMed and NexImmune. Research support for clinical trials from Incyte, Kite (Gilead) and Miltenyi Biotec. MS: Consultancy for McKinsey & Company, Omeros Corporation, and Angiocrine Bioscience. Has served ad hoc on the scientific advisory board of Kite—A Gilead Company. Research support for clinical trials from Angiocrine Bioscience. CSS: Has served as a paid consultant on advisory boards for: Juno Therapeutics, Sanofi-Genzyme, Spectrum Pharmaceuticals, Novartis, Genmab, Precision Biosciences, Kite, a Gilead Company, Celgene, Gamida Cell and GSK. Research support for clinical trials Juno Therapeutics, Celgene, Precision Biosciences and Sanofi-Genzyme.

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Gomez-Arteaga, A., Scordo, M., Tamari, R. et al. Use of anti-thymocyte globulin (ATG) for the treatment of pure red cell aplasia and immune-mediated cytopenias after allogeneic hematopoietic cell transplantation: a case series. Bone Marrow Transplant 55, 2326–2330 (2020). https://doi.org/10.1038/s41409-020-0939-9

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