The impact of antithymocyte globulin on short-term toxicity after allogeneic stem cell transplantation

被引:50
作者
Pihusch, R
Holler, E
Mühlbayer, D
Göhring, P
Stötzer, O
Pihusch, M
Hiller, E
Kolb, HJ
机构
[1] Univ Munich, Klinikum Grosshadern, Med Klin 3, D-81377 Munich, Germany
[2] Univ Munich, Klinikum Grosshadern, Inst Klin Chem, D-81377 Munich, Germany
[3] Univ Klinikum Regensburg, Abt Hematol & Intern Onkol, Regensburg, Germany
[4] GSF Forschungszentrum Umwelt & Gesundheit, Klin Kooperat Grp Hamatopoiet Zelltransplantat, Neuherberg, Germany
关键词
antithymocyte globulin; side-effects; treatment; transplantation;
D O I
10.1038/sj.bmt.1703640
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Antithymocyte globulin (ATG) is commonly used in allogeneic haematopoietic stem cell transplantation (HSCT). Little information is available, however, as to the optimal protocol for use and the side-effects occurring if ATG is administered in high daily doses (10-30 mg/kg). We report our experience with ATG Fresenius (ATG-F) in conditioning for allogeneic HSCT. During a period of 3 days, 47 patients received doses between 10 and 30 mg/kg either over 4 h preceded by 1-1.5 mg/kg prednisolone 30 min before the start of ATG-F (protocol A) or alternatively, over 12 h with 3-4 mg/kg prednisolone being administered before and 6 h after start of ATG (protocol B). During treatment with ATG-F, the side-effects observed included inflammation, disseminated intravascular coagulation, hyperdynamic circulation and renal dysfunction. Although these complications caused substantial morbidity, they were reversible within a few days. Side-effects were significantly more severe in patients treated according to protocol A than in those treated according to protocol B. As prolonged infusion of ATG-F does not reduce T cell clearance due to the long half-life of ATG-F, and since less cytokine release during conditioning might have beneficial long-term effects, we recommend administering ATG-F over 12 h preceded by high-dose steroid treatment.
引用
收藏
页码:347 / 354
页数:8
相关论文
共 28 条
  • [1] Al-Nawas B, 1996, Eur J Med Res, V1, P331
  • [2] HIGH SERUM PROCALCITONIN CONCENTRATIONS IN PATIENTS WITH SEPSIS AND INFECTION
    ASSICOT, M
    GENDREL, D
    CARSIN, H
    RAYMOND, J
    GUILBAUD, J
    BOHUON, C
    [J]. LANCET, 1993, 341 (8844) : 515 - 518
  • [3] Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin
    Brunkhorst, FM
    Eberhard, OK
    Brunkhorst, R
    [J]. CRITICAL CARE MEDICINE, 1999, 27 (10) : 2172 - 2176
  • [4] Buttgereit F, 1998, ARTHRITIS RHEUM, V41, P761, DOI 10.1002/1529-0131(199805)41:5<761::AID-ART2>3.0.CO
  • [5] 2-M
  • [6] CORTICOSTEROID INHIBITION OF THE OKT3-INDUCED CYTOKINE-RELATED SYNDROME - DOSAGE AND KINETICS PREREQUISITES
    CHATENOUD, L
    LEGENDRE, C
    FERRAN, C
    BACH, JF
    KREIS, H
    [J]. TRANSPLANTATION, 1991, 51 (02) : 334 - 338
  • [7] CORTICOSTEROID TREATMENT FOR SEPSIS - A CRITICAL-APPRAISAL AND METAANALYSIS OF THE LITERATURE
    CRONIN, L
    COOK, DJ
    CARLET, J
    HEYLAND, DK
    KING, D
    LANSANG, MAD
    FISHER, CJ
    [J]. CRITICAL CARE MEDICINE, 1995, 23 (08) : 1430 - 1439
  • [8] Monitoring anti-thymocyte globulin (ATG) in bone marrow recipients
    Eiermann, TH
    Lambrecht, P
    Zander, AR
    [J]. BONE MARROW TRANSPLANTATION, 1999, 23 (08) : 779 - 781
  • [9] IMMUNOSUPPRESSIVE TREATMENT OF APLASTIC-ANEMIA - RESULTS OF DIFFERENT TREATMENT REGIMENS IN 42 PATIENTS
    FRICKHOFEN, N
    HEIT, W
    RAGHAVACHAR, A
    PORZSOLT, F
    HEIMPEL, H
    [J]. DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT, 1987, 112 (14) : 535 - 541
  • [10] CLINICAL MANIFESTATIONS OF GRAFT VERSUS HOST DISEASE IN HUMAN RECIPIENTS OF MARROW FROM HL-A-MATCHED SIBLING DONORS
    GLUCKSBERG, H
    STORB, R
    FEFER, A
    BUCKNER, CD
    NEIMAN, PE
    CLIFT, RA
    LERNER, KG
    THOMAS, ED
    [J]. TRANSPLANTATION, 1974, 18 (04) : 295 - 304