DataSheet_5_Anti-Thymocyte Globulin Prophylaxis in Patients With Hematological Malignancies Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: An Updated Meta-Analysis.pdf

BackgroundAnti-thymocyte globulin (ATG) prophylaxis reduces graft-versus-host disease (GVHD) incidence. This meta-analysis aimed to explore the long-term efficacy of ATG and the influencing factors in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).MethodsPubMed, Embase, and Cochrane databases were searched for the relevant studies published up to August 2020. Data from randomized controlled trials (RCTs) on ATG prophylaxis for GVHD prevention in allo-HSCT patients were extracted.ResultsA total of eight relevant RCTs (1,348 patients) were included. ATG significantly reduced the incidence of grade III–IV aGVHD (P = 0.001) and cGVHD (P < 0.001). ATG significantly improved the GVHD relapse-free survival (GRFS) (P < 0.001). The immunosuppressive regimen (number and dose of immunosuppressants) was significantly reduced when using ATG (P = 0.005). Epstein-Barr virus (EBV) reactivation was high in patients receiving ATG (P = 0.003). No significant differences were detected in relapses, overall survival (OS), relapse-free survival (RFS), and non-relapse mortality (NRM) between the ATG and no ATG groups. Subgroup analyses revealed that the donor type and ATG formulation might be the possible sources of heterogeneity among the included studies. Meta-regression analysis showed that the cumulative dose of ATG did not affect GVHD, OS, relapse, RFS, and NRM.ConclusionAlthough ATG had no significant effect on relapse, RFS, and NRM, it significantly reduced the occurrence and severity of GVHD, improved the GRFS, and reduced the number and dose of immunosuppressants in patients undergoing allo-HSCT.

背景：抗胸腺细胞球蛋白（ATG）预防措施可降低移植物抗宿主病（GVHD）的发病率。本荟萃分析旨在探讨ATG的长期疗效及其在异基因造血干细胞移植（allo-HSCT）患者中的影响因素。方法：通过检索PubMed、Embase和Cochrane数据库，收集至2020年8月为止发表的相关研究。从关于allo-HSCT患者预防GVHD的随机对照试验（RCTs）中提取ATG预防措施的数据。结果：共纳入8项相关RCTs（患者1,348例）。ATG显著降低了III-IV级急性GVHD（P = 0.001）和慢性GVHD（P < 0.001）的发病率。ATG显著提高了GVHD无复发生存期（GRFS）（P < 0.001）。使用ATG时，免疫抑制方案（免疫抑制剂的种类和剂量）显著减少（P = 0.005）。接受ATG的患者中Epstein-Barr病毒（EBV）活化率较高（P = 0.003）。在复发生存率、总生存期（OS）、无复发生存期（RFS）和非复发生存死亡（NRM）方面，ATG组与无ATG组之间未检测到显著差异。亚组分析显示，供体类型和ATG配方可能是纳入研究中异质性的可能来源。元回归分析表明，ATG累积剂量对GVHD、OS、复发生存、RFS和非复发生存死亡无显著影响。结论：尽管ATG对复发生存、无复发生存和NRM无显著影响，但它显著降低了GVHD的发生率和严重程度，提高了GRFS，并减少了allo-HSCT患者中免疫抑制剂的种类和剂量。