Rabbit Antithymocyte Globulin Serum Levels: Factors Impacting the Levels and Clinical Outcomes Impacted by the Levels.
Biol Blood Marrow Transplant. 2018 Dec 17;:
Authors: Jamani K, Dabas R, Kangarloo SB, Prokopishyn NL, Luider J, Dharmani-Khan P, Khan FM, Daly A, Storek J
Antithymocyte globulin (ATG) levels and clearance vary significantly among patients receiving the same weight-based dose of ATG. To date, ATG area under the curve (AUC), its determinants and its impact on clinical outcomes, has been examined in pediatric hematopoietic cell transplant (HCT) and adult non-myeloablative HCT. Here we set out to examine ATG AUC in 219 uniformly treated adults undergoing myeloablative allogeneic HCT at our institution. Sera were collected for the determination of pre- or post-HCT ATG AUC. The lowest quintiles of pre- and post-HCT AUC were associated with inferior chronic graft-versus-host disease and relapse-free survival (cGRFS) and a higher risk of acute GVHD, respectively. The highest pre- or post-HCT ATG AUC quintiles were not associated with risk of death, non-relapse mortality or relapse. Factors most strongly associated with AUC were day -2 recipient absolute lymphocyte count, body mass index (BMI) and graft lymphocyte content. To achieve ideal pre-HCT AUC (avoiding low AUC to maxize cGRFS) in this HCT-setting, ATG dosing will need to take into consideration recipient weight, BMI and blood lymphocyte count as well as graft lymphocyte count. Further studies are required to 1) develop a modern ATG dosing schema, and, 2) demonstrate that adjusting ATG dose to target a particular AUC is feasible and leads to improved outcomes.
PMID: 30572108 [PubMed – as supplied by publisher]