Paper: Lower Dose of Antithymocyte Globulin (ATG) Decreases Infection Rate without Increasing Graft-Vs-Host Disease (GVHD) and Relapse in Patients Undergoing Reduced-Intensity (RIC) Allogeneic Hematopoeitic Stem Cell Transplant (HSCT)

Contributed Abstracts

Hall 1 (Salt Palace Convention Center)

Galena Salem, MD , Internal Medicine, Ohio State University, Columbus, OH

Amy S. Ruppert, MAS , Division of Hematology, Ohio State University Medical Center, Columbus, OH

Patrick Elder, MS , Blood and Marrow Transplantation Program, Arthur G. James Cancer Institute, Columbus, OH

Craig C Hofmeister, MD , Division of Hematology, Ohio State University Medical Center, Columbus, OH

Don M Benson, MD, PhD , Division of Hematology, The Ohio State University, Columbus, OH

Sam Penza, MD , Division of Hematology, The Ohio State University, Columbus, OH

Leslie A Andritsos, MD , Division of Hematology, The Ohio State University, Columbus, OH

Rebecca Klisovic, MD , Division of Hematology, Ohio State University Medical Center, Columbus, OH

Sumithira Vasu, MBBS , Division of Hematology, Ohio State University Medical Center, Columbus, OH

William Blum, MD , Division of Hematology, The Ohio State University, Columbus, OH

Steven M Devine, MD , Division of Hematology, The Ohio State University, Columbus, OH

Samantha Jaglowski, MD , Division of Hematology, Ohio State University Medical Center, Columbus, OH

Yvonne Efebera, MD , Division of Hematology, The Ohio State University, Columbus, OH

Background: Various doses of ATG have been utilized in RIC allogeneic transplantation targeting T cell depletion, with the goal of decreasing the incidence and severity of both acute and chronic GVHD. This is an update to the previously published data where we showed that lower ATG dose resulted in improved non-relapse mortality and infection rate without compromising control of GVHD.

Methods: We retrospectively analyzed 136 consecutive patients who received RIC HSCT between 2006 and 2010. Following October 2007, ATG dosing was lowered from 7.5 mg/kg (R-ATG) to 6 mg/kg (r-ATG). Progression-free (PFS) and overall survival (OS) were analyzed using the log-rank test. Cumulative incidences of GVHD were analyzed using Gray's test, accounting for competing risks.

Results: Thirty-nine patients received R-ATG and 97 received r-ATG. There were no significant differences in age, gender, KPS, degree of HLA match, prior autografts, donor/recipient CMV status, and CD34 cell dose between the two groups (p>0.15). More patients were transplanted with r-ATG than R-ATG for CLL and fewer with AML/MDS/NHL/HD/other histologies (p=0.02). Time to platelet engraftment as well as donor-cell chimerism at days +30, +90, +180 were not significantly different between the groups, but time to neutrophil engraftment was shorter with R-ATG (p=0.001). Proportions of aGVHD II-IV were 52% and 41% (p=0.34) in r-ATG and R-ATG respectively and proportions of cGVHD were 40% and 53% (p=0.23). Further, no significant differences in the cumulative incidence of GVHD were observed (Figure 1). The R-ATG group experienced more episodes of bacterial infections than the r-ATG cohort (54% vs. 8%; p<0.0001). No differences in PFS (p=0.69) or OS (p=0.95) were observed between the cohorts.

Conclusion: r-ATG did not result in an increase incidence of acute or chronic GVHD. No PFS or OS differences were observed between the cohorts; however, R-ATG resulted in a higher proportion of bacterial infections.

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391 Lower Dose of Antithymocyte Globulin (ATG) Decreases Infection Rate without Increasing Graft-Vs-Host Disease (GVHD) and Relapse in Patients Undergoing Reduced-Intensity (RIC) Allogeneic Hematopoeitic Stem Cell Transplant (HSCT)