The response-guided ATG treatment provides a survival benefit and KPS recovery for patients with steroid refractory acute GVHD: The Nagasaki Transplant Group Experience

Machiko Fujioka; Hidehiro Itonaga; Takafumi Furumoto; Sachie Kasai; Hikaru Sakamoto; Hideaki Kitanosono; Takeharu Kato; Makiko Horai; Shinya Sato; Yasushi Sawayama; Jun Taguchi; Yoshitaka Imaizumi; Tomoko Hata; Shinichiro Yoshida; Yukiyoshi Moriuchi; Yasushi Miyazaki

doi:10.1016/j.trim.2021.101417

The response-guided ATG treatment provides a survival benefit and KPS recovery for patients with steroid refractory acute GVHD: The Nagasaki Transplant Group Experience

Transpl Immunol. 2021 Aug:67:101417. doi: 10.1016/j.trim.2021.101417. Epub 2021 May 28.

Authors

Machiko Fujioka¹, Hidehiro Itonaga², Takafumi Furumoto³, Sachie Kasai⁴, Hikaru Sakamoto¹, Hideaki Kitanosono⁵, Takeharu Kato⁶, Makiko Horai⁷, Shinya Sato⁷, Yasushi Sawayama⁷, Jun Taguchi⁸, Yoshitaka Imaizumi⁷, Tomoko Hata⁷, Shinichiro Yoshida⁶, Yukiyoshi Moriuchi³, Yasushi Miyazaki⁹

Affiliations

¹ Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan; Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan.
² Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan. Electronic address: itoman820hide@outlook.jp.
³ Department of Hematology, Sasebo City General Hospital, Sasebo, Japan.
⁴ Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
⁵ Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan; Department of Hematology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.
⁶ Department of Hematology, National Hospital Organization Nagasaki Medical Center, Omura, Japan.
⁷ Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan.
⁸ Department of Hematology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan.
⁹ Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan; Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan; Department of Hematology, Atomic Bomb Disease and Hibakusha Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.

PMID: 34058354
DOI: 10.1016/j.trim.2021.101417

Abstract

Steroid-refractory acute graft-versus-host disease (SR-aGVHD) is a serious complication that negatively affects the prognosis and quality of life of patients who receive allogeneic hematopoietic stem cell transplantation (allo-HSCT). Antithymocyte globulin (ATG) is one of the second-line treatments for SR-aGVHD. We retrospectively evaluated Karnofsky Performance Status (KPS) recovery and clinical response in 11 patients who received the response-guided low-dose ATG treatment for SR-aGVHD after allo-HSCT using alternative donors. The median dose of ATG per cycle was 1.0 mg/kg (range, 1.0-1.25 mg/kg) and the median number of cycles of ATG was 2 (range, 1-4). The overall response rate was 63.6%, and the estimated overall survival rate at 1 year was 63.6%. Two out of seven patients who survived 1 year after the response-guided ATG treatment had KPS of 80 or higher. The remaining 5 patients had KPS of lower than 80 due to moderate chronic GVHD (cGVHD) and/or ≥grade 3 infectious complications. Based on the poor prognosis of patients with SR-aGVHD, the response-guided ATG treatment represents one therapeutic option. The present results also suggest that chronic GVHD and infectious complications after the response-guided ATG treatment were associated with decreased KPS recovery and impaired social function.

Keywords: Antithymocyte globulin (ATG); Steroid-refractory acute graft versus disease (GVHD).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute Disease
Adolescent
Adult
Antilymphocyte Serum / therapeutic use*
Drug Resistance
Female
Graft vs Host Disease / diagnosis
Graft vs Host Disease / mortality
Graft vs Host Disease / therapy*
Hematopoietic Stem Cell Transplantation*
Humans
Immunosuppressive Agents / therapeutic use*
Karnofsky Performance Status
Male
Middle Aged
Steroids / therapeutic use
Survival Analysis
Transplantation, Homologous
Young Adult

Substances

Antilymphocyte Serum
Immunosuppressive Agents
Steroids