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Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation2012; 18(12); 1876-1882; doi: 10.1016/j.bbmt.2012.07.004

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 Horse ATG has been replaced by rabbit ATG in many countries due to the unavailability of the former product.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.
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Publication Date: 2012-07-11 PubMed ID: 22796534DOI: 10.1016/j.bbmt.2012.07.004Google Scholar: Lookup
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  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

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

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
ISSN: 1523-6536
NlmUniqueID: 9600628
Country: United States
Language: English
Volume: 18
Issue: 12
Pages: 1876-1882
PII: S1083-8791(12)00271-6

Researcher Affiliations

Atta, Elias Hallack
  • CEMO, National Cancer Institute, Rio de Janeiro, Brazil.
de Sousa, Adriana Martins
    Schirmer, Marcelo Ribeiro
      Bouzas, Luis Fernando
        Nucci, Marcio
          Abdelhay, Eliana

            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

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