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No indication of increased infection rates using low‐dose alemtuzumab instead of anti‐thymocyte globulin as graft‐versus‐host disease prophylaxis before allogeneic stem cell transplantation
Author(s) -
Neumann Thomas,
Schneidewind Laila,
Thiele Thomas,
Pink Daniel,
Schulze Meike,
Schmidt Christian,
Krüger William
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12822
Subject(s) - alemtuzumab , medicine , anti thymocyte globulin , thymoglobulin , transplantation , hematopoietic stem cell transplantation , immunology , graft versus host disease , gastroenterology , cytomegalovirus , regimen , surgery , tacrolimus , virus , viral disease , herpesviridae
Background Alemtuzumab as part of the conditioning protocol is effective in reducing graft‐versus‐host disease (Gv HD ), but may be associated with increased infection rates, especially when using high doses (ie, 100 mg). Methods We performed a retrospective, single‐center, case‐control study analyzing the rates of neutropenic fever, cytomegalovirus ( CMV ) reactivation, Epstein‐Barr virus ( EBV ) reactivation, clinical manifest toxoplasmosis, and clinical manifest human herpesvirus‐6 ( HHV 6) infection using low‐dose alemtuzumab in comparison with anti‐thymocyte globulin ( ATG ) as Gv HD prophylaxis before allogeneic stem cell transplantation. Forty‐four patients transplanted from unrelated donors between 2001 and 2012 were matched by age, diagnosis, and conditioning regimen and treated either with alemtuzumab 10 mg at day −2 (respectively, 20 mg in case of mismatch transplantation) or ATG . ATG Fresenius (10 mg/kg for 3 days) or Thymoglobulin (2 mg/kg for 3 days) were used. Results Rates of CMV reactivation, EBV reactivation, and clinical manifest HHV 6 infection or toxoplasmosis did not differ significantly between both groups until 2 years after transplantation. No case of post‐transplant lymphoproliferative disorder was observed. Also, rates of neutropenic fever during inpatient treatment after transplantation did not differ significantly in both groups. Conclusion We saw no indication of increased infections rates when using low‐dose alemtuzumab as Gv HD prophylaxis before allogeneic stem cell transplantation in this retrospective analysis.