Comparison of rabbit ATLG and ATG for GVHD prophylaxis in hematological malignancies with haploidentical hematopoietic stem cell transplantation.

Rabbit anti-human T lymphocyte globulin (ATLG) and anti-thymocyte globulin (ATG) are commonly used for graft-versus-host disease (GVHD) prophylaxis in allogeneic hematopoietic stem cell transplantation (HSCT). Yet, their efficacy and safety have seldom been compared in hematological malignancies with haploidentical HSCT. A retrospective analysis with 28 ATLG (total dosage, 20-30 mg/kg) and 18 ATG (total dosage, 8-10 mg/kg) patients were performed. The cumulative incidences of chronic GVHD and relapse were comparable between both groups. ATLG showed a trend towards a lower acute GVHD incidence (28.6% vs. 44.4%, P = 0.242) and 3-year non-relapse mortality (10.7% vs. 27.8%, P = 0.160), and had a significantly higher 3-year overall survival (OS, 64.3% vs. 33.3%, P = 0.033) and GVHD-free and relapse-free survival (GRFS, 32.1% vs. 11.1%, P = 0.045) compared with ATG. Multivariate Cox regression analysis demonstrated ATLG was independently associated with a favorable OS (hazard ratio [HR] = 0.37, 95% confidence interval [CI]: 0.16-0.86, P = 0.020) and GRFS (HR = 0.51, 95%CI: 0.26-1.00, P = 0.051). Furthermore, ATLG had a lower risk of fever (25.0% vs. 61.1%, P = 0.014) and hemorrhage cystitis (7.1% vs. 38.9%, P = 0.008) than ATG-T. In conclusion, ATLG confers more survival benefit and a better safety profile than ATG and can be used in hematological malignancies with haploidentical HSCT. Prospective designed trials with a larger sample size are warranted to confirm the results in the future.

Clinical efficacy of Thalidomide combined with PAD Regimen in patients with multiple Myeloma.

Objective: To evaluate the clinical efficacy of thalidomide combined with PAD regimen in patients with multiple myeloma (MM). Methods: It was a Clinical comparative study. A total of 120 patients with MM were admitted at Beijing Aerospace General Hospital from September 2020 to June 2022 randomly divided into two groups, with 60 patients in each group. The study group was treated with thalidomide combined with a PAD regimen (bortezomib, doxorubicin and dexamethasone), while the control group with a PAD regimen alone. After treatment, the therapeutic effect, adverse drug reactions, bone metabolic markers such as serum alkaline phosphatase (ALP) and osteocalcin (OCN) before and after treatment, as well as T-lymphocyte subsets CD3+, CD4+, CD8+ and CD4+/CD8+ levels before and after treatment were compared and analyzed between the two groups. Results: The total efficacy in the study group was 90%, which was significantly higher than 70% in the control group (p= 0.00). The incidence of adverse drug reactions was 40% in the study group and 38% in the control group, without statistically significant difference (p= 0.85). After treatment, ALP and OCN levels in the study group were significantly higher than those in the control group (ALP, p= 0.01; OCN, p= 0.00), and CD3+, CD4+ and CD4+/CD8+ in the study group also increased significantly compared with those in the control group (CD3+, p= 0.02; CD4+, p= 0.00; CD4+/CD8+, p= 0.00). Conclusion: Thalidomide combined with a PAD regimen is definitely effective in patients with MM, it can obviously improve immune function and bone salt metabolism, with no increase in adverse reactions but high safety and effectiveness.

Post-transplant cyclophosphamide for GVHD prophylaxis in pediatrics with chronic active Epstein-Barr virus infection after haplo-HSCT.

BACKGROUND: Chronic active Epstein-Barr virus infection (CAEBV) is a rare but life-threatening progressive disease. Human leukocyte antigen (HLA)-haploidentical hematopoietic stem cell transplantation (haplo-HSCT) is the best choice as sometimes HLA-matched donor is not accessible. However, graft-versus-host-disease (GVHD) following transplantation remains a major cause of treatment failure and elevated mortality. Post-transplant cyclophosphamide (PTCy) has recently emerged for effective GVHD prophylaxis in a haploidentical setting in many hematologic malignancies. Here, we report the performance of PTCy for GVHD prophylaxis in a series of CEABV patients treated with haplo-HSCT. METHODS: Consecutive pediatric CAEBV patients who were treated with haplo-HSCT and give PTCy for GVHD prophylaxis were analyzed. 1-year GVHD and relapse-free survival (GRFS), overall survival (OS) and cumulative incidence of moderate-to-severe chronic GVHD (cGVHD) were estimated. RESULTS: A total of 8 patients ranging from 2 to 15 years old were included. Among them, 4 patients had early complications after haplo-HSCT. Counts of T-cell subsets increased within 6 months post transplantation, indicating an immune reconstitution. Only 1 patient developed grade II acute GVHD, and 2 patients had moderate cGVHD. One patient died from diffuse alveolar hemorrhage within the first year after transplantation. The 1-year GRFS rate, OS rate and cumulative incidence of moderate-to-severe cGVHD were 62.5%, 87.5% and 25.0%, respectively. CONCLUSION: Our findings suggest that, among CAEBV patients treated with haplo-HSCT, PTCy may be an alternative choice for the prevention of GVHD.