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  • Title: Impact of ATG-containing reduced-intensity conditioning after single- or double-unit allogeneic cord blood transplantation.
    Author: Pascal L, Tucunduva L, Ruggeri A, Blaise D, Ceballos P, Chevallier P, Cornelissen J, Maillard N, Tabrizi R, Petersen E, Linkesch W, Sengeloev H, Kenzey C, Pagliuca A, Holler E, Einsele H, Gluckman E, Rocha V, Yakoub-Agha I, Eurocord and the European Society for Blood and Marrow Transplantation.
    Journal: Blood; 2015 Aug 20; 126(8):1027-32. PubMed ID: 26160301.
    Abstract:
    We analyzed 661 adult patients who underwent single-unit (n = 226) or double-unit (n = 435) unrelated cord blood transplantation (UCBT) following a reduced-intensity conditioning (RIC) consisting of low-dose total body irradiation (TBI), cyclophosphamide, and fludarabine (Cy/Flu/TBI200). Eighty-two patients received rabbit antithymocyte globulin (ATG) as part of the conditioning regimen (ATG group), whereas 579 did not (non-ATG group). Median age at UCBT was 54 years, and diagnoses were acute leukemias (51%), myelodysplastic syndrome/myeloproliferative neoplasm (19%), and lymphoproliferative diseases (30%). Forty-four percent of patients were transplanted with advanced disease. All patients received ≥4 antigens HLA-matched UCBT. Median number of collected total nucleated cells was 4.4 × 10(7)/kg. In the ATG group, on 64 evaluable patients, ATG was discontinued 1 (n = 27), 2 (n = 20), or > 2 days before the graft infusion (n = 17). In multivariate analyses, the use of ATG was associated with decreased incidence of acute graft-versus-host disease (hazard ratio [HR], 0.31; 95% confidence interval [CI], 0.17-0.55; P < .0001), higher incidence of nonrelapse mortality (HR, 1.68; 95% CI, 1.16-2.43; P = .0009), and decreased overall survival (HR, 1.69; 95% CI, 1.19-2.415; P = .003). Collectively, our results suggest that the use of ATG could be detrimental, especially if given too close to graft infusion in adults undergoing UCBT following Cy/Flu/TBI200 regimen.
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