Patrick Daly

Cancer Nursing Today nonprod

Anti-T-lymphocyte globulin (ATLG) administered prior to allogeneic hematopoietic cell transplantation (HCT) has shown promise in preventing severe graft-versus-host disease (GVHD). However, according to Radwan Massoud and colleagues in Germany, data on the impact of different ATLG doses is sparse.In their study, published in Bone Marrow Transplantation, they reported that ATLG dose has a significant impact on immune reconstitution but not GVHD. Notably, the researchers also found that higher doses of ATLG were associated with delayed engraftment and increased incidence of infection.Compared to antithymocyte globulin (ATG), which is derived from rabbit vaccination with human thymocytes, rabbit ATLG is derived from the human Jurkat T-cell line.When working with ATG, nurses need to distinguish between rabbit or horse formulations in clinical trials due to the clinical practice implications. Horse ATG has more side effects, including the potential for an anaphylactic reaction, so it requires a test dose. In addition, rabbit ATG has a longer half-life and causes more severe and prolonged neutropenia and immunosuppression than horse ATG.<h3>Higher ATLG Dose Reduces GVHD but Increases Side Effects</h3>The retrospective study included 73 and 216 patients who received ATLG 30 mg/kg and 60 mg/kg, respectively, after undergoing myeloablative matched unrelated donor peripheral blood stem cell allogeneic HCT. Researchers used multicolor flow to assess T, B natural killer (NK), and natural killer T cells at 30, 100, and 180 days after transplantation.According to the report, the 60 mg/kg group had significantly delayed neutrophil and platelet engraftment, as well as higher cumulative incidences of infections (67% vs 75%; P=.049) and Epstein-Barr virus (EBV) reactivation (21% vs 41%; P=.049) at day 100.Comparatively, the 30 mg/kg group had faster reconstitution of na&iuml;ve B cells (P&lt;.0001) and &gamma;&delta; T cells (P=.045) at day 30 and faster reconstitution of na&iuml;ve helper T cells (P=.046), NK cells (P=.035), and na&iuml;ve B cells at day 180. Lastly, the authors noted there were no significant differences in acute GVHD (aGVHD), <a href="https://cancernursingtoday.com/post/characterizing-chronic-gvhd-after-ptcy-transplants">chronic GVHD</a>, nonrelapse mortality, relapse incidence, progression-free survival, and overall survival between the doses.Ultimately, the authors concluded that &ldquo;higher [ATLG] doses reduce aGVHD. However, they delay engraftment; impair B-cell, &gamma;&delta; T-cell, NK, and CD4+&thinsp;T-cell reconstitution; and increase the risk for infection and EBV reactivation.&rdquo; They did add that long-term outcomes were comparable.View More&nbsp;<a href="https://cancernursingtoday.com/page/gvhd">Expert Opinions and Recent Studies on Graft-Versus-Host Disease</a>

GVHD and Immune Reconstitution With Different ATLG Doses

GVHD

Different doses of ATLG prior to HCT had a significant impact on immune reconstitution, but not graft-versus-host disease during follow-up.

About Us

Editorial Policy

Authors

Advertising

eNewsletters

Contact Us

Contribute

Calendar of Events

Career Center

Blood Cancers Today

GU Oncology Now

DocWire News

MashupMD

Urban Health Today

Breast Cancer

Colorectal Cancer

GI Cancer

GU Cancer

Gynecologic Cancer Awareness Month

Gyn-Onc

Blood Cancer Awareness Month

Leukemia

Lymphoma

Myeloproliferative Neoplasms

Multiple Myeloma

Myelodysplastic Syndrome

Myelofibrosis

Sickle Cell

Hem/Onc

Professional Development

Patient Voice

Lung Cancer

Skin Cancer

Other Tumor Types

News

Treatment

More

Conferences

Calendar

CARE Award

Best Practices

Expert Interviews

Subscribe