Feasibility of conditioning with thymoglobulin and reduced intensity TBI to reduce acute GVHD in recipients of allogeneic SCT.
Publication/Presentation Date
12-1-2008
Abstract
Murine studies using anti-T-cell antibodies for conditioning in allogeneic SCT demonstrate engraftment with low rates of GVHD. On the basis of this preclinical model, we conditioned 30 patients with advanced hematologic malignancies with rabbit antithymocyte globulin (ATG) and TBI, to reduce rates of fatal acute GVHD. Patients were enrolled in two sequential groups: cohort 1 received ATG 10 mg/kg in divided doses (days -4 to -1)+200 cGy TBI (n=16), and cohort 2 received ATG (days -10 to -7)+450 cGy TBI (n=14). Median donor blood chimerism for the combined group was 94, 93 and 93% in the first, second and third months after transplant. Only three developed grade II acute GVHD despite 43% of patients receiving unrelated donor transplants. One-year survival was 71+/-11 and 54+/-14%, respectively, in recipients of related and unrelated donor SCT. Donor lymphocyte infusions were needed in 12 patients for the management of relapse and for mixed donor-recipient chimerism in 4 patients. We conclude that 10 mg/kg ATG and TBI allows engraftment with a low risk of acute GVHD; however, further dose optimization of ATG is required to achieve a balance between GVHD and disease relapse.
Volume
42
Issue
11
First Page
723
Last Page
731
ISSN
1476-5365
Published In/Presented At
Toor, A., Rodriguez, T., Bauml, M., Mathews, H., Shanti, S., Senitzer, D., Kini, A., Norton, J., Parthasarathy, M., Mohideen, N., Petrowsky, C., Bonilla, B., Smith, S., & Stiff, P. (2008). Feasibility of conditioning with thymoglobulin and reduced intensity TBI to reduce acute GVHD in recipients of allogeneic SCT. Bone marrow transplantation, 42(11), 723–731. https://doi.org/10.1038/bmt.2008.244
Disciplines
Medicine and Health Sciences
PubMedID
18711352
Department(s)
Department of Medicine, Hematology-Medical Oncology Division
Document Type
Article