Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia

Natasha Kekre; Ying Zhang; Mei Jie Zhang; Jeanette Carreras; Parvez Ahmed; Paolo Anderlini; Elias Hallack Atta; Mouhab Ayas; Jaap Jan Boelens; Carmem M. Bonfim; H. Joachim Deeg; Neena Kapoor; Jong Wook Lee; Ryotaro Nakamura; Michael A. Pulsipher; Mary Eapen; Joseph H Antin

doi:10.3324/haematol.2017.164459

Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia

Natasha Kekre, Ying Zhang, Mei Jie Zhang, Jeanette Carreras, Parvez Ahmed, Paolo Anderlini, Elias Hallack Atta, Mouhab Ayas, Jaap Jan Boelens, Carmem M. Bonfim, H. Joachim Deeg, Neena Kapoor, Jong Wook Lee, Ryotaro Nakamura, Michael A. Pulsipher, Mary Eapen^*, Joseph H Antin

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% versus 6%, P<0.001) and chronic (20% versus 9%, P<0.001) graft-versus-host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, P=0.76, respectively. Among recipients of unrelated donor transplants, acute graft-versus-host disease was also higher with horse compared to rabbit antithymocyte globulin (42% versus 23%, P<0.001) but not chronic graft-versus-host disease (38% versus 32%, P=0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% versus 83%, P=0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.

Original language	English
Pages (from-to)	1291-1298
Number of pages	8
Journal	Haematologica
Volume	102
Issue number	7
DOIs	https://doi.org/10.3324/haematol.2017.164459
Publication status	Published - Jul 2017

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Kekre, N., Zhang, Y., Zhang, M. J., Carreras, J., Ahmed, P., Anderlini, P., Atta, E. H., Ayas, M., Boelens, J. J., Bonfim, C. M., Joachim Deeg, H., Kapoor, N., Lee, J. W., Nakamura, R., Pulsipher, M. A., Eapen, M., & Antin, J. H. (2017). Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia. Haematologica, 102(7), 1291-1298. https://doi.org/10.3324/haematol.2017.164459

@article{6fa1f2719a0d43bbb0cc05c726d371b9,

title = "Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia",

abstract = "For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% versus 6%, P<0.001) and chronic (20% versus 9%, P<0.001) graft-versus-host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, P=0.76, respectively. Among recipients of unrelated donor transplants, acute graft-versus-host disease was also higher with horse compared to rabbit antithymocyte globulin (42% versus 23%, P<0.001) but not chronic graft-versus-host disease (38% versus 32%, P=0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% versus 83%, P=0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.",

author = "Natasha Kekre and Ying Zhang and Zhang, {Mei Jie} and Jeanette Carreras and Parvez Ahmed and Paolo Anderlini and Atta, {Elias Hallack} and Mouhab Ayas and Boelens, {Jaap Jan} and Bonfim, {Carmem M.} and {Joachim Deeg}, H. and Neena Kapoor and Lee, {Jong Wook} and Ryotaro Nakamura and Pulsipher, {Michael A.} and Mary Eapen and Antin, {Joseph H}",

note = "Funding Information: The Center for International Blood and Marrow Transplant Research is supported primarily by U24-CA76518 from the National Cancer Institute, the National Heart, Lung, and Blood InstituteNHLBI, and the National Institute of Allergy and Infectious Diseases and HHSH234200637015C from the Health Resources and Services Administration (HRSA/DHHS). The content is solely the responsibility of the authors and does not represent the official policy of the National Institutes of Health or the Health Resources and Services Administration. Publisher Copyright: {\textcopyright} 2017 Ferrata Storti Foundation.",

year = "2017",

month = jul,

doi = "10.3324/haematol.2017.164459",

language = "English",

volume = "102",

pages = "1291--1298",

journal = "Haematologica",

issn = "0390-6078",

publisher = "Ferrata Storti Foundation",

number = "7",

}

Kekre, N, Zhang, Y, Zhang, MJ, Carreras, J, Ahmed, P, Anderlini, P, Atta, EH, Ayas, M, Boelens, JJ, Bonfim, CM, Joachim Deeg, H, Kapoor, N, Lee, JW, Nakamura, R, Pulsipher, MA, Eapen, M & Antin, JH 2017, 'Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia', Haematologica, vol. 102, no. 7, pp. 1291-1298. https://doi.org/10.3324/haematol.2017.164459

TY - JOUR

T1 - Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia

AU - Kekre, Natasha

AU - Zhang, Ying

AU - Zhang, Mei Jie

AU - Carreras, Jeanette

AU - Ahmed, Parvez

AU - Anderlini, Paolo

AU - Atta, Elias Hallack

AU - Ayas, Mouhab

AU - Boelens, Jaap Jan

AU - Bonfim, Carmem M.

AU - Joachim Deeg, H.

AU - Kapoor, Neena

AU - Lee, Jong Wook

AU - Nakamura, Ryotaro

AU - Pulsipher, Michael A.

AU - Eapen, Mary

AU - Antin, Joseph H

N1 - Funding Information: The Center for International Blood and Marrow Transplant Research is supported primarily by U24-CA76518 from the National Cancer Institute, the National Heart, Lung, and Blood InstituteNHLBI, and the National Institute of Allergy and Infectious Diseases and HHSH234200637015C from the Health Resources and Services Administration (HRSA/DHHS). The content is solely the responsibility of the authors and does not represent the official policy of the National Institutes of Health or the Health Resources and Services Administration. Publisher Copyright: © 2017 Ferrata Storti Foundation.

PY - 2017/7

Y1 - 2017/7

N2 - For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% versus 6%, P<0.001) and chronic (20% versus 9%, P<0.001) graft-versus-host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, P=0.76, respectively. Among recipients of unrelated donor transplants, acute graft-versus-host disease was also higher with horse compared to rabbit antithymocyte globulin (42% versus 23%, P<0.001) but not chronic graft-versus-host disease (38% versus 32%, P=0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% versus 83%, P=0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.

AB - For treatment of severe aplastic anemia, immunosuppressive therapy with horse antithymocyte globulin results in superior response and survival compared with rabbit antithymocyte globulin. This relative benefit may be different in the setting of transplantation as rabbit antithymocyte globulin results in more profound immunosuppression. We analyzed 833 severe aplastic anemia transplants between 2008 and 2013 using human leukocyte antigen (HLA)-matched siblings (n=546) or unrelated donors (n=287) who received antithymocyte globulin as part of their conditioning regimen and bone marrow graft. There were no differences in hematopoietic recovery by type of antithymocyte globulin. Among recipients of HLA-matched sibling transplants, day 100 incidence of acute (17% versus 6%, P<0.001) and chronic (20% versus 9%, P<0.001) graft-versus-host disease were higher with horse compared to rabbit antithymocyte globulin. There were no differences in 3-year overall survival, 87% and 92%, P=0.76, respectively. Among recipients of unrelated donor transplants, acute graft-versus-host disease was also higher with horse compared to rabbit antithymocyte globulin (42% versus 23%, P<0.001) but not chronic graft-versus-host disease (38% versus 32%, P=0.35). Survival was lower with horse antithymocyte globulin after unrelated donor transplantation, 75% versus 83%, P=0.02. These data support the use of rabbit antithymocyte globulin for bone marrow transplant conditioning for severe aplastic anemia.

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DO - 10.3324/haematol.2017.164459

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SP - 1291

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JO - Haematologica

JF - Haematologica

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ER -

Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia

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