Rabbit Antithymocyte Globulin Versus Alemtuzumab in Allogeneic Stem Cell Transplantation：A Meta-Analysis

Hongju Yan , Lei Gao, Xi Zhang

Rabbit antithymocyte globulin (ATG) and alemtuzumab have been used for graft-versus-host disease(GVHD) prophylaxis in allogeneic haematopoietic stem cell transplantation(allo-HSCT), but which is more efficient remain unclear.we perform a meta-analysis of all studies comparing rabbit ATG and alemtuzumab for GVHD prophylaxis in allogeneic haematopoietic stem cell transplantation（HSCT） to evaluate their benefits and drawbacks. There are 7 studies (one prospective and six retrospective)for comparing   rabbit ATG vs alemtuzumab in GVHD prophylaxis with 622 patients. Our results showed that the incidence of grade II-IV acute GVHD (aGVHD) (RR 1.51, 95% CI 0.97–2.34, P = 0.07), incidence of grade III-IV acute GVHD (RR 1.48, 95% CI 0.63–3.47, P = 0.37) had a statistically non-significant reduction in alemtuzumab group, however, alemtuzumab significantly impaired OS (HR 0.61 (95% CI 0.41–0.90, P = 0.01) compared with ATG. The incidence of overall chronic GVHD(RR 0.97, 95% CI 0.67–1.40, P = 0.87) and the incidence of relapse(RR 1.03, 95% CI 0.72–1.47, P = 0.88) were similar in the two groups. We propose that using alemtuzumab for GVHD prophylaxis is effective for allogeneic stem cell transplantation due to the efficacy in grade III/IV acute GVHD, but OS is impaired compared with ATG group.