Table 5.
Outcomes of Allogeneic Transplant Studies Using Anti-Thymocyte Globulin for GVHD Prophylaxis
| Ref | n | Donor | ATG Dose | aGVHD | cGVHD | Toxicity | Rel/Prog |
|---|---|---|---|---|---|---|---|
| Bacigalupo (Ref 14) | No rATG 25 rATG 29 | Unrel | 7.5mg/kg rATG Sangstat | NS | NS | TRM p=NS | Survival p=NS |
| Bacigalupo (Ref 14) | No rATG 28 rATG 25 | Unrel | 15mg/kg rATG Sangstat | Grade III–IV 50% no rATG vs. 11% with rATG 11 (p=0.001) | In MVA, decreased risk of cGVHD with rATG | Infectious Deaths No rATG 7% With rATG 30% (p=0.02) In MVA, no decrease risk of TRM with rATG because of infectious deaths in high dose group |
Survival p=NS |
| Mohty (Ref 15) | Low dose rATG 55 High dose rATG 46 | HLA Id-sib | Low (2.5mg/kg) vs. High (7.5 or10mg/kg) rATG Sangstat | Gr II–IV 46% low vs. 24% high rATG (p=0.001) | Any cGVHD 76% low vs. 48% high rATG (p=0.02) rATG dose NS in MVA |
TRM p=NS | Rel/Prog 29% with GVHD vs. 52% no GVHD p=0.02 |
| Russell (Ref 22) | No rATG 54 rATG 54 | Rel | 4.5mg/kg rATG Sangstat | NS | 96% no rATG vs. 55% with rATG p=0.002 | 100 day NRM 17% no rATG vs. 4% with rATG 1 year NRM 34% no rATG vs. 9% with rATG |
4-yr Rel/Prog 22% no rATG vs. 43% with rATG p=0.05 |
| Basara (Ref 16) | No ATG 68 ATG 87 | Unrel | rATG Sangstat (5 to 15mg/kg) ATG Fresenius (45 or 60mg/kg) | NS | 76% no rATG vs. 36% rATG p=0.0001 | TRM no rATG vs. rATG p=NS | Rel/Prog p=NS LFS p=NS |
| Kröger (ref 18) | No ATG 57 ATG 45 | Rel | ATG Fresenius 30, 60 or 90 mg/kg | 47% no ATG vs. 20% with ATG (p=0.004) | 67% no ATG vs. 36% with ATG | TRM p=NS | Rel p=NS 5-yr DFS p=NS |
| Remberger (Ref 26) | No rATG 52 rATG 52 | Unrel | 10mg/kg rATG Sangstat | 5% no rATG vs. 12% with rATG | NS | NRM RR 0.30 with rATG p=0.005 CI 100 day NRM 21% no rATG vs. 6% with rATG |
Rel/Prog p=NS MVA RR death 0.5 with rATG p=0.03 |
| Remberger (Ref 19) | rATG 4mg/kg 51 6mg/kg 37 8mg/kg 19 10mg/kg 55 |
Unrel | 4mg/kg, 6mg/kg, 8mg/kg, or 10mg,kg rATG Sangstat | GrII OR 2.67 for 4mg/kg vs. other doses rATG in MVA (p=0.01) | NS | TRM OR 0.35 6–8mg/kg rATG (p=0.03) Death OR 0.45 for 6–8mg/kg rATG (p=0.03) |
Rel/Prog p=NS in MVA |
Abbreviations: ATG=anti-thymocyte globulin; cGVHD=chronic graft versus host disease; CI=cumulative incidence; DFS=disease free survival; GrII-IV=grade II–IV acute graft versus disease; HLA Id-sib=HLA identical sibling donor; LFS=leukemia free survival; MVA=multivariate analysis; NRM=non-relapse mortality; NS=not significant; OR=odds ratio; rATG=rabbit antithymocyte globulin; Rel=HLA matched related donor; Rel/Prog=relapse or progression; RR=relative risk; TRM=treatment related mortality; Unrel=HLA matched unrelated donor.