Abstract

Background Graft-Versus-Host Disease (GvHD) remains a major complication of Allogeneic Stem Cell Transplantation (alloSCT). Anti-Thymocyte Globulin (ATG), however, reduces the incidence and severity of GvHD after alloSCT. A small number of studies suggest a role for ATG in Match-Related Donor (MRD) alloSCT. The aim of this study was to assess the risk of acute and chronic GvHD, engraftment, survival, and mortality in patients who received ATG prior to MRD alloSCT. Methods A matched-pair analysis was performed among patients treated with MRD alloSCT after GvHD prophylaxis with ATG (ATG+) and MRD alloSCT transplanted patients with cyclosporine/methotrexate prophylaxis (non-ATG). Altogether 11 pairs were identified that could be matched exactly for age, gender, diagnoses, and disease stage at the time of transplantation, cytogenetic and molecular genetic risk group, as well as age and gender of donors. This prospective single-center study includes patients after MRD alloSCT only. Results All patients showed stable myeloid and platelet engraftment after alloSCT. On day +28, 91% of ATG+ and 73% of non-ATG patients showed complete donor chimerism (P < 0.03). The difference in acute GvHD was not significant. Chronic GvHD occurred in 60% of patients from ATG+ group and in all patients from control group (P < 0.0001). Extended chronic GvHD was observed in 22% and 50% of patients from ATG+ and non-ATG groups, respectively (P < 0.05). The differences in relapse, mortality, and overall survival in these groups of patients were not significant. Conclusions The addition of ATG to conventional GvHD prophylaxis was well tolerated and resulted in donor engraftment in this cohort of patients. Furthermore, conditioning with ATG led to a significant reduction in chronic GvHD without any increase in relapse.

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