Low-dose thymoglobulin as second-line treatment for steroid-resistant acute GvHD: An analysis of the JSHCT

M. Murata, K. Ikegame, Y. Morishita, H. Ogawa, K. Kaida, H. Nakamae, T. Ikeda, T. Nishida, M. Inoue, T. Eto, K. Kubo, T. Sakura, Takehiko Mori, N. Uchida, T. Ashida, Y. Matsuhashi, Y. Miyazaki, T. Ichinohe, Y. Atsuta, T. Teshima

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Abstract

A nationwide retrospective study for the clinical outcomes of 99 patients who had received thymoglobulin at a median total dose of 2.5 mg/kg (range, 0.5-18.5 mg/kg) as a second-line treatment for steroid-resistant acute GvHD was conducted. Of the 92 evaluable patients, improvement (complete or partial response) was observed in 55 patients (60%). Multivariate analysis demonstrated that male sex and grade III and IV acute GvHD were associated with a lower improvement rate, whereas thymoglobulin dose (<2.0, 2.0-3.9 and ≥4.0 mg/kg) was NS. Factors associated with significantly higher nonrelapse mortality included higher patient age (≥50 years), grade IV acute GvHD, no improvement of GvHD and higher dose of thymoglobulin (hazard ratio, 2.55; 95% confidence interval, 1.34-4.85; P=0.004 for 2.0-3.9 mg/kg group and 1.79; 0.91-3.55; P=0.093 for ≥4.0 mg/kg group). Higher dose of thymoglobulin was associated with a higher incidence of bacterial infections, CMV antigenemia and any additional infection. Taken together, low-dose thymoglobulin at a median total dose of 2.5 mg/kg provides a comparable response rate to standard-dose thymoglobulin reported previously, and <2.0 mg/kg thymoglobulin is recommended in terms of the balance between efficacy and adverse effects.

Original languageEnglish
Pages (from-to)252-257
Number of pages6
JournalBone Marrow Transplantation
Volume52
Issue number2
DOIs
Publication statusPublished - 2017 Feb 1

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ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Murata, M., Ikegame, K., Morishita, Y., Ogawa, H., Kaida, K., Nakamae, H., Ikeda, T., Nishida, T., Inoue, M., Eto, T., Kubo, K., Sakura, T., Mori, T., Uchida, N., Ashida, T., Matsuhashi, Y., Miyazaki, Y., Ichinohe, T., Atsuta, Y., & Teshima, T. (2017). Low-dose thymoglobulin as second-line treatment for steroid-resistant acute GvHD: An analysis of the JSHCT. Bone Marrow Transplantation, 52(2), 252-257. https://doi.org/10.1038/bmt.2016.247