rdf:type |
|
lifeskim:mentions |
umls-concept:C0003442,
umls-concept:C0009647,
umls-concept:C0021311,
umls-concept:C0026565,
umls-concept:C0030705,
umls-concept:C0040739,
umls-concept:C0178602,
umls-concept:C0184511,
umls-concept:C0376545,
umls-concept:C0441994,
umls-concept:C1521828
|
pubmed:issue |
11
|
pubmed:dateCreated |
2009-10-13
|
pubmed:abstractText |
We sought to reduce the risk of infectious complications and nonrelapse mortality (NRM) associated with the use of antithymocyte globulin (ATG) without compromising control of acute graft-versus-host disease (aGVHD) in patients undergoing reduced-intensity conditioning (RIC) transplantation. As part of an ongoing quality improvement effort, we lowered the dose of rabbit ATG from 7.5 mg/kg of ATG (R-ATG) (n = 39) to 6.0 mg/kg of ATG (r-ATG) (n = 33) in association with fludarabine (Flu) and busulfan (BU) RIC transplantation and then monitored patients for adverse events, relapse, and survival. Of the 72 mostly high risk (82%) patients studied, 89% received unrelated donor allografts, 25% of which were HLA-mismatched. No differences in posttransplantation full donor-cell chimerism rates were observed between the 2 ATG-dose groups (P > .05). When R-ATG versus r-ATG patients were compared, we observed no significant difference in the cumulative incidence of grade II-IV aGVHD (32% versus 27%; P = .73) or grade III-IV aGVHD (23% versus 11%; P = .28). However, the r-ATG group had significantly less cytomegalovirus (CMV) reactivation (64% versus 30%; P = .005) and bacterial infections (56% versus 18%; P = .001), a better 1-year cumulative incidence of NRM (18% versus 3%; P = .03), and a trend for better 1-year overall survival (OS) (64% versus 84%; P = .07) compared to R-ATG patients. A seemingly modest reduction in the dose of rabbit ATG did not compromise control of aGVHD or achievement of donor chimerism, but led to a significant decrease in the risk of serious infections and NRM in high-risk RIC allograft recipients.
|
pubmed:language |
eng
|
pubmed:journal |
|
pubmed:citationSubset |
IM
|
pubmed:chemical |
|
pubmed:status |
MEDLINE
|
pubmed:month |
Nov
|
pubmed:issn |
1523-6536
|
pubmed:author |
pubmed-author:AndritsosLeslieL,
pubmed-author:BechtelThomasT,
pubmed-author:BensonDon MDM,
pubmed-author:BlumWilliamW,
pubmed-author:ByrdJohn CJC,
pubmed-author:DevineSteven MSM,
pubmed-author:ElderPatrickP,
pubmed-author:GarzonRamiroR,
pubmed-author:HamadaniMehdiM,
pubmed-author:HofmeisterCraigC,
pubmed-author:KlisovicRebeccaR,
pubmed-author:KrughDavidD,
pubmed-author:LinThomasT,
pubmed-author:MarcucciGuidoG,
pubmed-author:O'DonnellLynnL,
pubmed-author:PenzaSamS,
pubmed-author:PhillipsGaryG
|
pubmed:issnType |
Electronic
|
pubmed:volume |
15
|
pubmed:owner |
NLM
|
pubmed:authorsComplete |
Y
|
pubmed:pagination |
1422-30
|
pubmed:meshHeading |
pubmed-meshheading:19822302-Adult,
pubmed-meshheading:19822302-Aged,
pubmed-meshheading:19822302-Animals,
pubmed-meshheading:19822302-Anti-Infective Agents,
pubmed-meshheading:19822302-Antilymphocyte Serum,
pubmed-meshheading:19822302-Busulfan,
pubmed-meshheading:19822302-Disease Susceptibility,
pubmed-meshheading:19822302-Female,
pubmed-meshheading:19822302-Graft vs Host Disease,
pubmed-meshheading:19822302-Hematologic Neoplasms,
pubmed-meshheading:19822302-Hematopoietic Stem Cell Transplantation,
pubmed-meshheading:19822302-Humans,
pubmed-meshheading:19822302-Immunocompromised Host,
pubmed-meshheading:19822302-Immunosuppressive Agents,
pubmed-meshheading:19822302-Infection,
pubmed-meshheading:19822302-Infection Control,
pubmed-meshheading:19822302-Male,
pubmed-meshheading:19822302-Medical Audit,
pubmed-meshheading:19822302-Methotrexate,
pubmed-meshheading:19822302-Middle Aged,
pubmed-meshheading:19822302-Myeloablative Agonists,
pubmed-meshheading:19822302-Patient Isolation,
pubmed-meshheading:19822302-Postoperative Complications,
pubmed-meshheading:19822302-Rabbits,
pubmed-meshheading:19822302-T-Lymphocytes,
pubmed-meshheading:19822302-Tacrolimus,
pubmed-meshheading:19822302-Transplantation, Homologous,
pubmed-meshheading:19822302-Transplantation Conditioning,
pubmed-meshheading:19822302-Vidarabine,
pubmed-meshheading:19822302-Young Adult
|
pubmed:year |
2009
|
pubmed:articleTitle |
Improved nonrelapse mortality and infection rate with lower dose of antithymocyte globulin in patients undergoing reduced-intensity conditioning allogeneic transplantation for hematologic malignancies.
|
pubmed:affiliation |
Division of Hematology/Oncology, Blood and Marrow Transplantation Section, and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio 43210, USA. mehdi.hamadani@gmail.com
|
pubmed:publicationType |
Journal Article,
Clinical Trial
|