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Journals / Uluslararası Hematoloji-Onkoloji Dergisi / 2015 / Cilt: 25 - Sayı: 4

Steroide Dirençli Akut Graft Versus Host Hastalığının Tedavisinde Antilenfosit / Timosit Globulin: Bir Merkezdeki 20 Yıllık Deneyim

Antilymphocyte/Thymocyte Globulin for the Treatment of Steroid-Refractory Acute Graft-Versus-Host Disease: 20-Year Experience at a Single Center

Mehmet ÖZEN
Sinem C BOZDAG
Guzin CAKMAK
PERVİN TOPÇUOĞLU
Ayse H EROGLU
Mehmet GÜNDÜZ
ÖNDER ARSLAN
Taner DEMİRER
Hamdi AKAN
Osman İLHAN
MERAL BEKSAÇ
Günhan GÜRMAN
MUHİT ÖZCAN
Pages
236–244
DOI
—
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

An overall response was observed in 15 patients (42%), with similar response rates among patients treated with any of the three ATG preparations.

📌 3 Key Takeaways

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Objective & Hypothesis:Although there is currently no consensus regarding the treatment of steroid-refractory acute graft-versus-host disease (GvHD) after hematopoietic stem cell transplantation (HSCT), antithymocyte globulin (ATG) is one of the most widely used immunosuppressive drugs in this setting.
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Key Findings & Data:We retrospectively summarized our transplant center's experience with 35 steroid-resistant acute GvHD patients who were treated with three different ATG preparations.
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Conclusion & Impact:An overall response was observed in 15 patients (42%), with similar response rates among patients treated with any of the three ATG preparations.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters

Abstract

Although there is currently no consensus regarding the treatment of steroid-refractory acute graft-versus-host disease (GvHD) after hematopoietic stem cell transplantation (HSCT), antithymocyte globulin (ATG) is one of the most widely used immunosuppressive drugs in this setting. We retrospectively summarized our transplant center's experience with 35 steroid-resistant acute GvHD patients who were treated with three different ATG preparations. Severe (grade III-IV) acute GvHD was observed either during the posttransplantation period (n= 32) or after donor lymphocyte infusion (n= 3). For secondary treatment of acute GvHD, rabbit Jurkat cell linereactive ATG (ATG Fresenius®) (n= 22), rabbit thymus cell-reactive ATG (Thymoglobulin®) (n= 9) or equine antilymphocyte globulin (ALG) (Lymphoglobulin®) (n= 4) was administered at a dose of 2-10 mg/kg/day for five consecutive days. The median time from the diagnosis of acute GvHD to the first day of infusion of ATG or ALG was 15 days (3-70 days). An overall response was observed in 15 patients (42%), with similar response rates among patients treated with any of the three ATG preparations. The overall survival (OS) of the patients did not increase in any treatment group, though the severity of GvHD and the disease status before HSCT were shown to negatively impact OS. Although responses could be achieved in steroid-refractory acute GvHD using rabbit or horse ATG, survival rates did not increase because of high mortality rates due to infection during treatment.

Özet

Yıllık DeneyimHematopoetik kök hücre nakli (HKHN) sonrası gelişen steroide dirençli akut graft versus host hastalığı (GVHH) tedavisinde, günümüzde üzerine uzlaşma olmamasına rağmen antitimosit globulin (ATG) bu durumda geniş çaplı olarak kullanılan immünsüpresif ilaçlardan biridir. Üç farklı ATG formu ile tedavi edilen 35 steroide dirençli akut GVHH hastası hakkında nakil merkezimizin tecrübesini geriye dönük olarak özetledik. Ciddi akut GVHH nakil sonrası dönemde (n= 32) veya donör lenfosit infüzyonundan sonra (n= 3) gözlendi. Akut GVHH'nin ikincil tedavisinde tavşan Jurkat hücre dizisi reaktif ATG (ATG Fresenius®) (n= 22), tavşan timus hücresi reaktif ATG (Thymoglobulin®) (n= 9) veya at antilenfosit globulin (ALG) (Lymphoglobulin®) (n= 4) ardışık 5 gün boyunca 2-10 mg/kg/gün dozunda uygulandı. Akut GVHH tanısından ATG veya ALG'nin ilk infüzyon gününe kadarki ortanca süre 15 gündü. Toplam yanıt 15 (%42) hastada gözlenirken, üç ATG formunun herhangi biri ile tedavi edilmiş hastalar arasında benzer yanıt oranları vardı. Hastaların toplam sağkalımı (TS) hiçbir tedavi grubunda artmazken, GVHH'nin ciddiyeti ve HKHN öncesi hastalık durumu TS'yi negatif etkiledi. Steroide dirençli akut GVHH'de at veya tavşan ATG kullanımı ile yanıt elde edilmesine rağmen, tedavi sırasındaki infeksiyona bağlı yüksek mortalite oranları nedeniyle sağkalım artmadı.

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Cite This Article

ÖZEN, M., BOZDAG, S. C., CAKMAK, G., TOPÇUOĞLU, P., EROGLU, A. H., GÜNDÜZ, M., ARSLAN, Ö., DEMİRER, T., AKAN, H., İLHAN, O., BEKSAÇ, M., GÜRMAN, G., ÖZCAN, M. (2015). Steroide Dirençli Akut Graft Versus Host Hastalığının Tedavisinde Antilenfosit / Timosit Globulin: Bir Merkezdeki 20 Yıllık Deneyim. Uluslararası Hematoloji-Onkoloji Dergisi, Cilt: 25 - Sayı: 4, 236–244. https://ajindex.com/articles/322860

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