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Role of antithymocyte globulin in patients with hematologic diseases undergoing umbilical cord blood transplantation: A systematic review and meta‐analysis
Author(s) -
Qin Baozhen,
Zhang Chao,
Zhang Rui,
Wang Li
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13876
Subject(s) - medicine , umbilical cord blood transplantation , transplantation , gastroenterology , umbilical cord , meta analysis , cochrane library , graft versus host disease , surgery , immunology , hematopoietic stem cell transplantation
The role of antithymocyte globulin (ATG) in patients with hematologic diseases undergoing umbilical cord blood transplantation (UCBT) remains controversial. This systematic review and meta‐analysis was conducted to comprehensively evaluate this issue. PubMed, Embase, and the Cochrane Library were systematically searched. Clinical studies reporting the impact of ATG‐ vs non‐ATG‐containing conditioning regimens on transplantation outcomes were identified. Twenty‐five studies were included. ATG significantly prevented grade II‐IV and grade III‐IV acute graft‐vs‐host disease (GVHD) (11 studies, 5020 patients, HR: 0.49, 95% CI: 0.42‐0.56, P < .001; 5 studies, 5490 patients, HR: 0.60, 95% CI: 0.46‐0.80, P < .001) but not chronic GVHD (8 studies, 5952 patients, HR: 0.78, 95% CI: 0.51‐1.20, P = .266). However, use of ATG was associated with increased transplantation‐related mortality and inferior overall survival (9 studies, 4244 patients, HR: 1.79, 95% CI: 1.38‐2.33, P < .001; 8 studies, 5438 patients, HR: 1.96, 95% CI: 1.56‐2.46, P < .001). Our study did not recommend routine use of ATG in UCBT. Individualizing the ATG timing and dose based on patient characteristics to retain the prophylactic effects of ATG on GVHD without compromising the survival of UCBT recipients may be reasonable.