한빛사논문
Byung-Sik Cho1,2, Gi-June Min1,2, Sung-Soo Park1,2, Seok Yoon Yoon3, Silvia Park1,2, Young-Woo Jeon4, Seung-Hwan Shin5, Seung-Ah Yahng6, Jae-Ho Yoon1,2, Sung-Eun Lee1,2, Ki-Seong Eom1,2, Yoo-Jin Kim1,2, Chang-Ki Min1,2, Seok-Goo Cho1, Dong-Wook Kim1,2, Jong Wook Lee1, Hee-Je Kim1,2,*, Seok Lee1,2,*
1Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
2Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
3Department of Hematology, Soon Chun Hyang University Hospital, College of Medicine, Soon Chun Hyang University of Korea, Seoul, Republic of Korea
4Department of Hematology, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
5Department of Hematology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
6Department of Hematology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Byung-Sik Cho and Gi-June Min were equally contributors.
*Correspondence : Seok Lee and Hee-Je Kim
Abstract
Despite the proven efficacy of anti-T-cell or antithymocyte globulin (ATG) for chronic graft-versus-host disease (GVHD) prevention in transplantation from an unrelated donor, dosing protocols and the effects of ATG on relapse and infection remain controversial. In the setting of transplantation from an HLA-matched sibling (MSD-T), few randomized studies have been conducted. We conducted a prospective, single-center, open-label, randomized study of low-dose thymoglobulin (2.5 mg/kg) for chronic GVHD prevention. A total of 120 patients with acute leukemia were randomly assigned in a 1:1 ratio. After a median follow-up of 27 months, the cumulative incidence of chronic GVHD in the ATG and non-ATG groups was 25.0% and 65.4% (p < 0.001), respectively. The ATG group had an increased relapse rate compared with the non-ATG-group (20.0% vs. 9.3%; p = 0.055), with risks that differed according to cytogenetic subgroup (high-risk, 29.6% vs. 9.3%, p = 0.042; non-high-risk, 12.2% vs. 9.2%, p = 0.596). Chronic GVHD-free and relapse-free survival (cGRFS) was higher in the ATG group (46.7% vs. 19.4%; p = 0.070), and the difference was significant in a cytogenetic non-high-risk subgroup (45.5% vs. 0%; p = 0.038). No differences were observed in other survival outcomes. Improved physical components in quality-of-life scores were observed in the ATG group at 12 months after transplantation. A higher rate of Epstein–Barr virus reactivation was observed in the ATG group (21.8% vs. 5.1%; p = 0.013), whereas no between-group differences for other complications. In conclusion, the low-dose thymoglobulin effectively prevented chronic GVHD in MSD-T, resulting in improvement in quality-of-life and cGRFS, whereas the necessity of caution for high-risk acute leukemia.
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