ATG And Basiliximab As Acute Graft-versus-host Disease Prophylaxis For Haploidentical Hematopoietic Stem Cell Transplantation

Objective: We intended to compare the efficacy of a novel regimen combining basiliximab,rabbit anti-thymocyte globulin(Thymoglobulin a total of 5 mg/kg)and conventional immunosuppressive agents such as cyclosporin A,mycophenolate mofetil and methotrexate for the prevention of GVHD in the recipients of haplo-HSCT.Methods: From July 2010 to December 2017,thirty-four(34)patients who received haplo-HSCT at the Second affiliated Hospital of Chongqing Medical University were included in a retrospective study(Chongqing,China).All patients included in the study were followed longitudinally until death or lost to follow-up.Rate of hematopoietic recovery,GVHD,virus activation,relapse were calculated using cumulative incidence.The Kaplan-Meier method was used to estimate OS and DFS.Results: The median follow-up duration was 15.5 months(range: 1.5-76 months).The cumulative incidence of grade II–IV and grade III–IV aGVHD was 38.2% and 11.8% at 100 days,while the rates of limited and extensive cGVHD were 17.6% and 23.5% at 1 year,respectively.Laboratory evidence of CMV reactivation from peripheral blood PCR was found in 9 patients(26.5%);and 6 patients(18.8%)developed Epstein-Barr virus reactivation.Only one patient developed post-transplant lymphoproliferative disease.The relapse rate of haplo-HSCT was 14.7% at 1 year;and 1-year overall survival(OS)and disease-free survival(DFS)were achieved in 58.8% and 55.9% of the patients,respectively.Conclusion: The combination of ATG and basiliximab in haplo-HSCT yielded encouraging engraftment results with low incidence of viral reactivation and did not significantly increase the incidence of acute GVHD.These results suggested that this new regimen could be a promising treatment strategy for the prevention of aGVHD in haplo-HSCT patients.