Different outcomes between cyclophosphamide plus horse or rabbit antithymocyte globulin for HLA-identical sibling bone marrow transplant in severe aplastic anemia.
Abstract: The standard regimen for HLA-identical sibling bone marrow transplant (BMT) in severe aplastic anemia (SAA) is cyclophosphamide (Cy) and horse antithymocyte globulin (ATG). Horse ATG has been replaced by rabbit ATG in many countries due to the unavailability of the former product. This study was designed to assess if these ATG preparations are interchangeable in the preparative regimen for matched related BMT in SAA. Forty consecutive BMTs were retrospectively analyzed: 20 received Cy plus horse ATG and 20 received Cy plus rabbit ATG as the preparative regimen. Conditioning with rabbit ATG was protective against acute graft-versus-host disease (aGVHD) grades II-IV and moderate-severe chronic GVHD (cGVHD), with incidence rates of 0% versus 35.2% (P = .009) and 0% versus 34.0% (P = .04), respectively. On day +100, the probability of proven/probable invasive fungal disease (IFD) was higher in patients conditioned with rabbit ATG, 31.2% versus 5.5%, respectively (P = .04). Earlier cytomegalovirus (CMV) reactivation (40 versus 50 days; P = .02) was observed with rabbit ATG. An inferior lymphocyte count on days +30 (0.360 versus 0.814 × 10(9)/L; P = .01) and +90 (0.744 versus 1.330 × 10(9)/L; P = .006) was noticed in recipients of rabbit ATG. The incidence of stable mixed chimerism was higher in recipients of rabbit ATG (18.2% versus 80%, respectively; P = .004). These results suggest that horse and rabbit ATG preparations have different biological and clinical properties and should not be used interchangeably in the preparative regimen for related BMT in SAA.
Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Publication Date: 2012-07-11 PubMed ID: 22796534DOI: 10.1016/j.bbmt.2012.07.004Google Scholar: Lookup
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- Journal Article
Summary
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This research study looks at how the combination of cyclophosphamide with either horse or rabbit antithymocyte globulin affects patients receiving a bone marrow transplant from an identical sibling for the treatment of severe aplastic anemia. The results indicate marked differences in outcomes between the two treatments, suggesting that they are not interchangeable as previously thought.
Objective of the study
- The primary aim of the research is to determine the interchangeability of horse and rabbit antithymocyte globulin (ATG) in combination with cyclophosphamide (Cy) for conditioning prior to a bone marrow transplant in individuals with severe aplastic anemia.
Methods
- The researchers retrospectively assessed the outcomes of 40 consecutive bone marrow transplants.
- Twenty of these cases received cyclophosphamide plus horse ATG while the remaining twenty received cyclophosphamide and rabbit ATG for conditioning before the transplant.
Key findings
- The study found that conditioning with rabbit ATG resulted in fewer instances of acute graft-versus-host disease (aGVHD) and chronic GVHD (cGVHD).
- However, a higher incidence of invasive fungal disease was observed in patients conditioned with rabbit ATG.
- Rabbit ATG was associated with a higher rate of cytomegalovirus (CMV) reactivation, and patients conditioned with rabbit ATG had a lesser lymphocyte count on days +30 and +90.
- Recipients of rabbit ATG also exhibited a higher incidence of stable mixed chimerism.
Conclusion
- The study concludes that the biological and clinical properties of horse and rabbit antithymocyte globulins vary significantly, and cannot be used interchangeably in the conditioning regimen for bone marrow transplants in individuals with severe aplastic anemia.
Cite This Article
APA
Atta EH, de Sousa AM, Schirmer MR, Bouzas LF, Nucci M, Abdelhay E.
(2012).
Different outcomes between cyclophosphamide plus horse or rabbit antithymocyte globulin for HLA-identical sibling bone marrow transplant in severe aplastic anemia.
Biol Blood Marrow Transplant, 18(12), 1876-1882.
https://doi.org/10.1016/j.bbmt.2012.07.004 Publication
Researcher Affiliations
- CEMO, National Cancer Institute, Rio de Janeiro, Brazil.
MeSH Terms
- Adolescent
- Adult
- Anemia, Aplastic / drug therapy
- Anemia, Aplastic / immunology
- Anemia, Aplastic / surgery
- Anemia, Aplastic / therapy
- Animals
- Antilymphocyte Serum / therapeutic use
- Bone Marrow Transplantation / adverse effects
- Bone Marrow Transplantation / immunology
- Bone Marrow Transplantation / methods
- Child
- Child, Preschool
- Combined Modality Therapy
- Cyclophosphamide / therapeutic use
- Horses
- Humans
- Middle Aged
- Rabbits
- Survival Analysis
- Young Adult
Citations
This article has been cited 14 times.- Chakupurakal G, Freudenberger P, Skoetz N, Ahr H, Theurich S. Polyclonal anti-thymocyte globulins for the prophylaxis of graft-versus-host disease after allogeneic stem cell or bone marrow transplantation in adults.. Cochrane Database Syst Rev 2023 Jun 21;6(6):CD009159.
- Zhang Y, Chen X, Li L, Li Y, Lin L, Cao Y, Wang N, Yang D, Pang A, Zhang R, Ma Q, Zhai W, He Y, Wei J, Jiang E, Han M, Zhang Y, Feng S. Retrospective Comparison of Efficacy and Safety of Rabbit Anti-Thymocyte Globulin and Porcine Anti-Lymphocyte Globulin in Patients With Acquired Aplastic Anemia Undergoing Hematopoietic Stem Cell Transplantation From Matched Sibling Donors.. Front Immunol 2022;13:889784.
- Loke J, Buka R, Craddock C. Allogeneic Stem Cell Transplantation for Acute Myeloid Leukemia: Who, When, and How?. Front Immunol 2021;12:659595.
- Iftikhar R, Ahmad P, de Latour R, Dufour C, Risitano A, Chaudhri N, Bazarbachi A, De La Fuente J, Höchsmann B, Osman Ahmed S, Gergis U, Elhaddad A, Halkes C, Albeirouti B, Alotaibi S, Kulasekararaj A, Alzahrani H, Ben Othman T, Cesaro S, Alahmari A, Rihani R, Alshemmari S, Hamidieh AA, Bekadja MA, Passweg J, Al-Khabori M, Rasheed W, Bacigalupo A, Chaudhry QU, Ljungman P, Marsh J, El Fakih R, Aljurf M. Special issues related to the diagnosis and management of acquired aplastic anemia in countries with restricted resources, a report on behalf of the Eastern Mediterranean blood and marrow transplantation (EMBMT) group and severe aplastic anemia working party of the European Society for blood and marrow transplantation (SAAWP of EBMT).. Bone Marrow Transplant 2021 Oct;56(10):2518-2532.
- Im SH, Kim BR, Park SM, Yoon BA, Hwang TJ, Baek HJ, Kook H. Better Failure-Free Survival and Graft-versus-Host Disease-Free/Failure Free Survival with Fludarabine-Based Conditioning in Stem Cell Transplantation for Aplastic Anemia in Children.. J Korean Med Sci 2020 Feb 24;35(7):e46.
- Georges GE, Doney K, Storb R. Severe aplastic anemia: allogeneic bone marrow transplantation as first-line treatment.. Blood Adv 2018 Aug 14;2(15):2020-2028.
- Savaşan S. Acquired Aplastic Anemia: What Have We Learned and What Is in the Horizon?. Pediatr Clin North Am 2018 Jun;65(3):597-606.
- Kekre N, Zhang Y, Zhang MJ, Carreras J, Ahmed P, Anderlini P, Atta EH, Ayas M, Boelens JJ, Bonfim C, Deeg HJ, Kapoor N, Lee JW, Nakamura R, Pulsipher MA, Eapen M, Antin JH. Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia.. Haematologica 2017 Jul;102(7):1291-1298.
- Baron F, Mohty M, Blaise D, Socié G, Labopin M, Esteve J, Ciceri F, Giebel S, Gorin NC, Savani BN, Schmid C, Nagler A. Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.. Haematologica 2017 Feb;102(2):224-234.
- Gallo S, Woolfrey AE, Burroughs LM, Storer BE, Flowers ME, Hari P, Pulsipher MA, Heimfeld S, Kiem HP, Sandmaier BM, Storb R. Marrow grafts from HLA-identical siblings for severe aplastic anemia: does limiting the number of transplanted marrow cells reduce the risk of chronic GvHD?. Bone Marrow Transplant 2016 Dec;51(12):1573-1578.
- Maschan M, Shelikhova L, Ilushina M, Kurnikova E, Boyakova E, Balashov D, Persiantseva M, Skvortsova Y, Laberko A, Muzalevskii Y, Kazachenok A, Glushkova S, Bobrynina V, Kalinina V, Olshanskaya Y, Baidildina D, Novichkova G, Maschan A. TCR-alpha/beta and CD19 depletion and treosulfan-based conditioning regimen in unrelated and haploidentical transplantation in children with acute myeloid leukemia.. Bone Marrow Transplant 2016 May;51(5):668-74.
- Vo PT, Pantin J, Ramos C, Cook L, Cho E, Kurlander R, Khuu H, Barrett J, Leitman S, Childs RW. Conditioning with rabbit versus horse ATG dramatically alters clinical outcomes in identical twins with severe aplastic anemia transplanted with the same allogeneic donor.. J Hematol Oncol 2015 Jun 26;8:78.
- Pantin J, Tian X, Shah AA, Kurlander R, Ramos C, Cook L, Khuu H, Stroncek D, Leitman S, Barrett J, Donohue T, Young NS, Geller N, Childs RW. Rapid donor T-cell engraftment increases the risk of chronic graft-versus-host disease following salvage allogeneic peripheral blood hematopoietic cell transplantation for bone marrow failure syndromes.. Am J Hematol 2013 Oct;88(10):874-82.
- Ram R, Storb R. Pharmacologic prophylaxis regimens for acute graft-versus-host disease: past, present and future.. Leuk Lymphoma 2013 Aug;54(8):1591-601.
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