Treatment May Limit Graft-Versus-Host Disease

Problem in stem-cell transplants is common when donor, recipient are not related

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WEDNESDAY, Aug. 19, 2009 (HealthDay News) -- People who need a blood stem-cell transplant may be able to lessen the chances that the transplanted material will attack the body -- what's known as graft-versus-host disease -- by being treated with anti-T-cell globulin, a new study has shown.

Graft-versus-host disease (GVHD) occurs in up to 60 percent of those who have a transplant of blood stem cells -- called hematopoietic cell transplantation -- from the bone marrow or peripheral blood of unrelated donors. In GVHD, the immune system or T-cells from the donor recognize the recipient's tissues as foreign and attack. Previous research has suggested that antibodies that eliminate T-cells might prevent this attack.

The new study included 201 adults with blood cancer who were scheduled for a transplant from an unrelated donor. One group was given standard treatment to prevent GVHD prophylaxis (cyclosporine and methotrexate), and the others were given the standard therapy plus anti-T-cell globulin (anti-Jurkat ATG-Fresenius, or ATG-F).

Within 100 days, about 34 percent (33 people) in the standard treatment group had developed acute GVHD or had died, compared with 21 percent (22 people) of those in the ATG-F group. The difference during the first 100 days was not considered statistically significant, the researchers noted.

However, the study found that the overall incidence of acute GVHD was less in the ATG-F group (12 percent) than among those who'd gotten just the standard treatment (24 percent). One person given ATG-F died, compared with nine who had not gotten ATG-F.

The phase 3 trial also found that the two-year cumulative incidence of chronic GVHD and extensive chronic GVHD in the ATG-F group was about 31 percent and 12 percent, respectively, compared with 59 percent and 43 percent for the standard treatment group.

The ATG-F group did not have higher rates than the standard treatment group for relapse, deaths not related to relapse or deaths from infection, the study authors found.

"This is the first randomized clinical trial to show that ATG-F can reduce severe acute and clinically relevant chronic GVHD without compromising disease-free survival or overall survival," Dr. Jurgen Finke, of Universitatsklinikum Freiburg in Germany, and fellow researchers said in a news release from The Lancet Oncology, which is publishing the study online Aug. 19 and in its September print issue.

"The use of ATG-F is safe for patients who are going to receive transplantation from matched unrelated donors," they said.

More information

The U.S. National Library of Medicine has more on graft-versus-host disease.

SOURCE: The Lancet Oncology, news release, Aug. 18, 2009

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