PMID- 18456390
OWN - NLM
STAT- MEDLINE
DCOM- 20080919
LR  - 20131121
IS  - 0301-472X (Print)
IS  - 0301-472X (Linking)
VI  - 36
IP  - 8
DP  - 2008 Aug
TI  - Anti-thymocyte globulin overcomes the negative impact of HLA mismatching in 
      transplantation from unrelated donors.
PG  - 1047-54
LID - 10.1016/j.exphem.2008.03.011 [doi]
AB  - OBJECTIVE: About one third of patients requiring allogeneic hematopoetic stem 
      cell transplantation (HSCT) would not find a matched sibling or alternative 
      donor. Allogeneic HSCT from matched unrelated and mismatched donors carries an 
      increased risk of graft-vs-host disease (GVHD) and transplant-related mortality 
      (TRM). MATERIALS AND METHODS: We used anti-thymocyte globulin (ATG-Fresenius) at 
      a median dose of 90 mg/kg body weight as part of a total body irradiation or 
      busulfan-based conditioning regimen for prevention of serious GVHD. All patients 
      received cyclosporine A and short-course methotrexate. We compared outcomes of 65 
      recipients of human leukocyte antigen (HLA)-mismatched unrelated grafts and 194 
      recipients of HLA-matched unrelated grafts. Mismatches involved one or two loci. 
      Both groups were comparable in age, graft source, diagnosis, stage of disease, 
      and conditioning regimen, and differed only in dose of ATG administered. RESULTS: 
      For matched and mismatched transplants, respectively, there was no significant 
      difference in graft failure (0.5% vs 3%; p = 0.16), in the cumulative incidence 
      of grade II to IV acute GVHD (45% vs 35%; p = 0.14) and no difference in overall 
      chronic GVHD (42% vs 40%; p = 0.68). Estimated overall survival (OS) and 
      disease-free survival (DFS) at 5 years were 55% vs 50% (p = 0.99) and 47% vs 47% 
      (p = 1.0), respectively. The cumulative incidence of relapse and TRM at 5 years 
      were 24% vs 25% (p = 0.63), and 29% vs 27% (p = 0.59), respectively. CONCLUSION: 
      Inclusion of ATG-Fresenius in the conditioning regimen permits HSCT from 
      mismatched unrelated donors without excess TRM and GVHD, resulting in identical 
      OS and DFS of recipients of HLA-matched and HLA-mismatched grafts.
FAU - Ayuk, Francis
AU  - Ayuk F
AD  - Department of Stem Cell Transplantation, University Medical Center Hamburg, 
      Hamburg, Germany. ayuketan@uke.uni-hamburg.de
FAU - Diyachenko, Galina
AU  - Diyachenko G
FAU - Zabelina, Tatjana
AU  - Zabelina T
FAU - Panse, Jens
AU  - Panse J
FAU - Wolschke, Christine
AU  - Wolschke C
FAU - Eiermann, Thomas
AU  - Eiermann T
FAU - Binder, Thomas
AU  - Binder T
FAU - Fehse, Boris
AU  - Fehse B
FAU - Erttmann, Rudolf
AU  - Erttmann R
FAU - Kabisch, Hartmut
AU  - Kabisch H
FAU - Bacher, Ulrike
AU  - Bacher U
FAU - Kroger, Nicolaus
AU  - Kroger N
FAU - Zander, Axel R
AU  - Zander AR
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
DEP - 20080505
PL  - Netherlands
TA  - Exp Hematol
JT  - Experimental hematology
JID - 0402313
RN  - 0 (Antilymphocyte Serum)
RN  - 0 (Immunosuppressive Agents)
RN  - 83HN0GTJ6D (Cyclosporine)
RN  - YL5FZ2Y5U1 (Methotrexate)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Antilymphocyte Serum/*therapeutic use
MH  - Child
MH  - Child, Preschool
MH  - Cyclosporine/therapeutic use
MH  - Disease-Free Survival
MH  - Female
MH  - Follow-Up Studies
MH  - Graft vs Host Disease/*prevention & control
MH  - Hematopoietic Stem Cell Transplantation/*methods
MH  - Histocompatibility Testing
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Infant
MH  - Leukemia/*therapy
MH  - Male
MH  - Methotrexate/therapeutic use
MH  - Middle Aged
MH  - Myelodysplastic Syndromes/*therapy
MH  - Survival Rate
MH  - Transplantation Conditioning/*methods
EDAT- 2008/05/06 09:00
MHDA- 2008/09/20 09:00
CRDT- 2008/05/06 09:00
PHST- 2007/12/15 00:00 [received]
PHST- 2008/01/31 00:00 [revised]
PHST- 2008/03/03 00:00 [accepted]
PHST- 2008/05/06 09:00 [pubmed]
PHST- 2008/09/20 09:00 [medline]
PHST- 2008/05/06 09:00 [entrez]
AID - S0301-472X(08)00125-2 [pii]
AID - 10.1016/j.exphem.2008.03.011 [doi]
PST - ppublish
SO  - Exp Hematol. 2008 Aug;36(8):1047-54. doi: 10.1016/j.exphem.2008.03.011. Epub 2008 
      May 5.