Antithymocyte globulin for graft-versus-host disease prophylaxis: an updated systematic review and meta-analysis.
Ambuj KumarTea ReljicMehdi HamadaniMohamad MohtyMohamed A Kharfan-DabajaPublished in: Bone marrow transplantation (2018)
Graft-versus-host disease (GVHD) remains a limiting factor for successful allogeneic hematopoietic cell transplantation (allo-HCT). Conflicting data exist on the benefit of ATG on post-transplant survival. We performed a systematic review of randomized controlled trials (RCTs) to assess benefits and harms of thymoglobulin and Fresenius (re-branded as Grafalon) ATG formulations in patients undergoing allo-HCT for a variety of hematologic malignancies and bone marrow failure syndromes. A comprehensive search of MEDLINE, EMBASE, and Cochrane Library was performed. Data on methodological quality, benefits, and harms were extracted for each trial and pooled under a random-effects model. Eight RCTs (1134 patients) met the inclusion criteria. Methodological quality ranged from moderate to very low. Pooled results showed no difference in overall survival (OS) with the use of ATG (hazard ratio (HR) = 0.97; 95% confidence interval (CI) = 0.74-1.28; P = 0.83). ATG reduced grade II/III acute GVHD (risk ratio (RR) = 0.61; 95% CI = 0.48-0.77; P < 0.0001), grade III/IV acute GVHD (RR = 0.52; 95% CI = 0.34-0.81; P = 0.004), and chronic GVHD (RR = 0.52; 95% CI = 0.40-0.69; P < 0.00001) without an increase in non-relapse mortality (NRM) (RR = 0.91; 95% CI = 0.74-1.13; P = 0.40). Future studies with better methodological quality are needed to provide conclusive answers related to optimal dosing and timing of ATG for prevention of GVHD.
Keyphrases
- allogeneic hematopoietic stem cell transplantation
- bone marrow
- liver failure
- patients undergoing
- drug induced
- electronic health record
- respiratory failure
- end stage renal disease
- ejection fraction
- quality improvement
- free survival
- phase iii
- mesenchymal stem cells
- clinical trial
- acute myeloid leukemia
- acute lymphoblastic leukemia
- stem cell transplantation
- big data
- randomized controlled trial
- cardiovascular events
- type diabetes
- intensive care unit
- cardiovascular disease
- risk factors
- coronary artery disease
- open label
- tyrosine kinase
- phase ii
- placebo controlled