Rabbit Anti-T Cell Globulin in Allogeneic Hematopoietic Cell Transplantation

被引:85
作者
Storek, Jan [1 ,2 ]
Mohty, Mohamad [3 ,4 ]
Boelens, Jaap Jan [5 ,6 ]
机构
[1] Alberta Blood & Marrow Transplant Program, Calgary, AB, Canada
[2] Univ Calgary, Calgary, AB T2N 4N1, Canada
[3] Hop St Antoine, Dept Hematol & Cellular Therapy, F-75571 Paris, France
[4] Univ Paris 06, Paris, France
[5] Univ Med Ctr Utrecht, Pediat Blood & Marrow Transplantat Program, Utrecht, Netherlands
[6] Univ Med Ctr Utrecht, Lab Translat Immunol, Sect Tumor Immunol, Utrecht, Netherlands
关键词
Antithymocyte globulin; Graft-versus-host disease; Hematopoietic cell; transplantation; VERSUS-HOST-DISEASE; BONE-MARROW-TRANSPLANTATION; MATCHED UNRELATED DONORS; LEUKEMIA WORKING PARTY; ACUTE MYELOID-LEUKEMIA; DOSE CYCLOSPORINE-A; TERM-FOLLOW-UP; ANTITHYMOCYTE GLOBULIN; THYMOCYTE GLOBULIN; IMMUNE RECONSTITUTION;
D O I
10.1016/j.bbmt.2014.11.676
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Anti-T cell globulin (ATG) is polyclonal IgG from rabbits immunized with human thymocytes or a human T cell line. Prophylaxis using ATG infused with conditioning for adult marrow or blood stem cell transplantation reduces both acute and chronic graft-versus-host disease (GVHD). However, ATG is not or minimally efficacious in steroid refractory GVHD treatment. Regarding preemptive therapy. ATG is promising; however, further work is needed on establishing adequate biomarkers to be used as triggers for preemptive therapy before it can be used routinely. Relapse is not increased by ATG, except possibly in the setting of reduced-intensity conditioning. Infections are probably increased when using high but not low-dose ATG, except for Epstein-Barr virus driven post-transplantation lymphoproliferative disorder, which may be increased even with low-dose ATG. Survival is not improved with ATG: however, survival free of immunosuppressive therapy is improved. Pharmacokinetics of ATG are highly variable, resulting in highly variable areas under the time-concentration curves. Optimized dosing of ATG might improve transplantation outcomes. In conclusion, ATG reduces GVHD and, thus, may improve quality of life, without compromising survival. 2015 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:959 / 970
页数:12
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