Comparison of different rabbit ATG preparation effects on early lymphocyte subset recovery after allogeneic HSCT and its association with EBV-mediated PTLD

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Item Type:	Article
Title:	Comparison of different rabbit ATG preparation effects on early lymphocyte subset recovery after allogeneic HSCT and its association with EBV-mediated PTLD
Creators Name:	Mensen, A., Na, I.K., Häfer, R., Meerbach, A., Schlecht, M., Pietschmann, M.L. and Gruhn, B.
Abstract:	Purpose: Rabbit antithymocyte globulin (ATG) is commonly used before allogeneic hematopoietic stem cell transplantation (allo-HSCT) to prevent graft-versus-host disease. Studies comparing the effect of different ATG preparations and dosages on immune reconstitution and risk for Epstein-Barr virus (EBV)-mediated post-transplant lymphoproliferative disorder (PTLD) are rare. Methods: In this retrospective study, we determined T and B cell subsets by flow cytometry after allo-HSCT in children, who received ATG-Genzyme (ATG-G, n = 15), ATG-Fresenius (ATG-F, n = 25) or no-ATG treatment (n = 19). Additionally, PCR-quantified EBV-genome copy counts were correlated with incidence of PTLD. Results: We could confirm a dose-dependent impairment of CD8+ and CD4+ T cell regeneration by ATG-G, including naïve and memory CD4+ T cells. No differences were seen between the currently applied dosages of 5-10 mg/kg ATG-G and 20-60 mg/kg ATG-F. Significantly delayed T cell subset reconstitution was determined only at high dosages of 20-60 mg/kg ATG-G compared to ATG-F. B cell reconstitution was comparably impaired in ATG-G- and ATG-F-treated patients. Although the incidence of EBV reactivation was similar in both ATG groups, EBV copy counts of >104 copies/105 peripheral blood mononuclear cells and the occurrence of PTLD were only found in ATG-G-treated patients. Conclusions: We conclude that high, but importantly not currently applied low dosages of ATG-G, impair thymic T cell regeneration and memory T cell immunity to a greater extent than ATG-F in pediatric patients. In addition, our results suggest an increased risk for EBV-PTLD when treated with ATG-G. Prospective studies are warranted to compare different ATG preparations with regard to the immune reconstitution and EBV-PTLD.
Keywords:	Pediatric allo-HSCT, ATG-genzyme, ATG-Fresenius, Immune Reconstitution, EBV Reactivation, EBV-PTLD, Animals, Rabbits
Source:	Journal of Cancer Research and Clinical Oncology
ISSN:	0171-5216
Publisher:	Springer
Volume:	140
Number:	11
Page Range:	1971-1980
Date:	November 2014
Official Publication:	https://doi.org/10.1007/s00432-014-1742-z
PubMed:	View item in PubMed

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