Differential elimination of anti-thymocyte globulin of Fresenius and genzyme impacts T-cell reconstitution after hematopoietic stem cell transplantation

Lisa V.E. Oostenbrink, Cornelia M. Jol-Van Der Zijde, Katrine Kielsen, Anja M. Jansen-Hoogendijk, Marianne Ifversen, Klaus G. Müller, Arjan C. Lankester, Astrid G.S. Van Halteren, Robbert G.M. Bredius, Marco W. Schilham, Maarten J.D. Van Tol

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41 Citaten (Scopus)

Samenvatting

Anti-thymocyte globulin (ATG) is a lymphocyte depleting agent applied in hematopoietic stem cell transplantation (HSCT) to prevent rejection and Graft-vs.-Host Disease (GvHD). In this study, we compared two rabbit ATG products, ATG-Genzyme (ATG-GENZ), and ATG-Fresenius (ATG-FRES), with respect to dosing, clearance of the active lymphocyte binding component, post-HSCT immune reconstitution and clinical outcome. Fifty-eigth pediatric acute leukemia patients (n = 42 ATG-GENZ, n = 16 ATG-FRES), who received a non-depleted bone marrow or peripheral blood stem cell graft from an unrelated donor were included. ATG-GENZ was given at a dosage of 6-10 mg/kg; ATG-FRES at 45-60 mg/kg. The active component of ATG from both products was cleared at different rates. Within the ATG-FRES dose range no differences were found in clearance of active ATG or T-cell re-appearance. However, the high dosage of ATG-GENZ (10 mg/kg), in contrast to the low dosage (6-8 mg/kg), correlated with prolonged persistence of active ATG and delayed T-cell reconstitution. Occurrence of serious acute GvHD (grade III-IV) was highest in the ATG-GENZ-low dosage group. These results imply that dosing of ATG-GENZ is more critical than dosing of ATG-FRES due to the difference in clearance of active ATG. This should be taken into account when designing clinical protocols.

Originele taal-2Engels
Artikelnummer315
TijdschriftFrontiers in Immunology
Volume10
Nummer van het tijdschriftMAR
DOI's
StatusGepubliceerd - 2019
Extern gepubliceerdJa

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