HLA-mismatched haploidentical transplantation using low-dose anti-thymocyte globulin (ATG: thymoglobulin).

Abstract

OBJECTIVES:

To clarify optimal strategies for human leukocyte antigen (HLA)-mismatched haploidentical hematopoietic stem cell transplantation (HSCT).

METHODS:

Twelve patients who underwent HSCT from a haploidentical related donor using low-dose thymoglobulin were analyzed retrospectively. Thymoglobulin was added to conditioning regimens at 2.5 mg/kg/day for 2 days (days -4 and -3). Prophylaxis against graft-versus-host disease (GVHD) was performed with cyclosporine and methotrexate.

RESULTS:

The median age of the patients was 33 years. Six patients had previous allogeneic HSCT, and HSCT was performed in non-remission for nine patients. All patients but one, who died due to early infection, achieved neutrophil engraftment at a median of 17 days with complete donor-type chimerism. Acute and chronic GVHD were observed in six and five patients, respectively, but no patients died of GVHD-associated complication. No one developed cytomegalovirus disease, but Epstein-Barr virus-related lymphoproliferative disorder was observed in one patient. Long-term survival in remission without immunosuppressive agents are observed in two patients who underwent HSCT in remission, but the majority of patients who underwent HSCT in non-remission experienced disease progression.

CONCLUSION:

Haploidentical HSCT could be performed with thymoglobulin at 5 mg/kg, with the balance between GVHD and relapse rate. The dose reduction of thymoglobulin may be considered for advanced hematological malignancy.

• Authors: Shinichi Kako, Yu Akahoshi, Naonori Harada, Hirofumi Nakano, Kazuaki Kameda, Tomotaka Ugai, Ryoko Yamasaki, Hidenori Wada, Yuko Ishihara, Koji Kawamura, Kana Sakamoto, Miki Sato, Masahiro Ashizawa, Kiriko Terasako-Saito, Shun-Ichi Kimura, Misato Kikuchi, Hideki Nakasone, Rie Yamazaki, Junya Kanda, Yoshinobu Kanda
• Journal: Hematology (Amsterdam, Netherlands) (Hematology) Vol. 22 Issue 3 Pg. 129-135 (Apr 2017) ISSN: 1607-8454 [Electronic] England
• PMID: 27905258 (Publication Type: Journal Article)

Chemical References

• Antilymphocyte Serum
• HLA Antigens
• Immunosuppressive Agents
• thymoglobulin

Topics

• Adolescent
• Adult
• Antilymphocyte Serum (administration & dosage)
• Disease Progression
• Female
• Graft Survival
• Graft vs Host Disease (etiology, prevention & control)
• HLA Antigens (genetics, immunology)
• Haplotypes
• Hematologic Neoplasms (complications, diagnosis, therapy)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Retrospective Studies
• Transplantation Chimera
• Transplantation Conditioning (adverse effects, methods)
• Transplantation, Homologous
• Treatment Outcome
• Young Adult