Contributions
Abstract: EP830
Type: E-Poster Presentation
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Antithymocyte globulin (ATG) utilization in HSCT for prophylaxis of GvHD is increasing. ATG administration can be complicated by infusion reactions, sometimes severe leading to treatment interruption or discontinuation. At our center, two protocols have been used with different infusion times.
Aims
The aim from this analysis was twofold; to compare the incidence of reactions between the two infusion protocols and to identify factors associated with infusion reactions.
Methods
Following IRB approval, patients that underwent HSCT from 2011 to 2020 and received ATG were included. From 2011-2015, ATG was infused over 6 hours while from 2016-2020, ATG was infused over 24 hours split over 2 bags given at 12 hours each. All patients received pre-medications with acetaminophen 1000 mg, diphenhydramine 25 mg and hydrocortisone 50 mg with additional doses in case of reactions. All variables were retrospectively collected. Categorical and continuous variables were compared using chi-squared or Kruskal-Wallis, as appropriate. Logistic regression was used for multivariable analysis incorporating variables with p values of ≤ 0.1 at the univariable stage as well as unbalanced factors between the groups. Specifically; age, gender, diagnosis, stem cell source, conditioning intensity and absolute lymphocyte count (ALC) prior to ATG.
Results
A. Baseline Characteristics: During the study period, a total of 74 patients received thymoglobulin ATG. The median age was 32 years (14-63) and 41 (55%) were males. Underlying diagnosis was malignant in 45 (61%) and non-malignant in the remaining 29 (39%). Myeloablative conditioning was used in 27 (36%) and 11 (15%) received TBI. Most donors (56, 76%) were matched related and 54 (73%) received peripheral blood stem cells (PBSC).
B. Stratification by Infusion Time: A total of 11 (15%) received ATG as short infusion while the remaining 63 (85%) received it via long infusion. The short infusion cohort was significantly younger with higher proportion of female patients (P = 0.041). PBSCs were used more commonly in the long infusion group (P = 0.035). NMA conditioning was significantly used more commonly in the short infusion cohort and accordingly, ALC at ATG infusion was significantly higher as well (P = 0.012 and 0.007, respectively). Other characteristics were similar between the two cohorts (Table 1).
C. Infusion Reactions: Patients receiving short infusion had a significantly higher number of any infusion reactions (P<0.0001) as well as moderate to severe reactions (P<0.0001). Activation of critical care response team (CCRT) and transfer to the intensive care unit (ICU) was significantly higher in the short infusion group (p<0.0001). Interruption or discontinuation of ATG infusion occurred significantly more frequently in the short infusion cohort (P = 0.0001 and < 0.0001, respectively). Time to neutrophil and platelet engraftment as well as incidence of cytomegalovirus reaction requiring pre-emptive therapy was similar in the two groups (Table 2). In multivariable analysis for infusion reactions, only ALC count was predictive with OR 5.9 (1.6-21.9; P = 0.0087) (Table 3).
Conclusion
Prolonging the ATG infusion time significantly decreased reactions leading to lower treatment interruption or discontinuation. Importantly, severe reactions or the need for critical care services was almost not seen in the long infusion group permitting smooth administration of the conditioning regimen. Reactions were also independently increased with higher ALC levels. These observations warrant further validation.
Keyword(s): ATG, Transplant
Abstract: EP830
Type: E-Poster Presentation
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Antithymocyte globulin (ATG) utilization in HSCT for prophylaxis of GvHD is increasing. ATG administration can be complicated by infusion reactions, sometimes severe leading to treatment interruption or discontinuation. At our center, two protocols have been used with different infusion times.
Aims
The aim from this analysis was twofold; to compare the incidence of reactions between the two infusion protocols and to identify factors associated with infusion reactions.
Methods
Following IRB approval, patients that underwent HSCT from 2011 to 2020 and received ATG were included. From 2011-2015, ATG was infused over 6 hours while from 2016-2020, ATG was infused over 24 hours split over 2 bags given at 12 hours each. All patients received pre-medications with acetaminophen 1000 mg, diphenhydramine 25 mg and hydrocortisone 50 mg with additional doses in case of reactions. All variables were retrospectively collected. Categorical and continuous variables were compared using chi-squared or Kruskal-Wallis, as appropriate. Logistic regression was used for multivariable analysis incorporating variables with p values of ≤ 0.1 at the univariable stage as well as unbalanced factors between the groups. Specifically; age, gender, diagnosis, stem cell source, conditioning intensity and absolute lymphocyte count (ALC) prior to ATG.
Results
A. Baseline Characteristics: During the study period, a total of 74 patients received thymoglobulin ATG. The median age was 32 years (14-63) and 41 (55%) were males. Underlying diagnosis was malignant in 45 (61%) and non-malignant in the remaining 29 (39%). Myeloablative conditioning was used in 27 (36%) and 11 (15%) received TBI. Most donors (56, 76%) were matched related and 54 (73%) received peripheral blood stem cells (PBSC).
B. Stratification by Infusion Time: A total of 11 (15%) received ATG as short infusion while the remaining 63 (85%) received it via long infusion. The short infusion cohort was significantly younger with higher proportion of female patients (P = 0.041). PBSCs were used more commonly in the long infusion group (P = 0.035). NMA conditioning was significantly used more commonly in the short infusion cohort and accordingly, ALC at ATG infusion was significantly higher as well (P = 0.012 and 0.007, respectively). Other characteristics were similar between the two cohorts (Table 1).
C. Infusion Reactions: Patients receiving short infusion had a significantly higher number of any infusion reactions (P<0.0001) as well as moderate to severe reactions (P<0.0001). Activation of critical care response team (CCRT) and transfer to the intensive care unit (ICU) was significantly higher in the short infusion group (p<0.0001). Interruption or discontinuation of ATG infusion occurred significantly more frequently in the short infusion cohort (P = 0.0001 and < 0.0001, respectively). Time to neutrophil and platelet engraftment as well as incidence of cytomegalovirus reaction requiring pre-emptive therapy was similar in the two groups (Table 2). In multivariable analysis for infusion reactions, only ALC count was predictive with OR 5.9 (1.6-21.9; P = 0.0087) (Table 3).
Conclusion
Prolonging the ATG infusion time significantly decreased reactions leading to lower treatment interruption or discontinuation. Importantly, severe reactions or the need for critical care services was almost not seen in the long infusion group permitting smooth administration of the conditioning regimen. Reactions were also independently increased with higher ALC levels. These observations warrant further validation.
Keyword(s): ATG, Transplant