Impact of using Low Dose versus High Dose Antithymocyte Globulin Based Conditioning Regimen on the Outcome of Peripheral Blood Stem Cell Transplantation in Children with βeta-thalassemia Major

Abstract

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) is the only commonly available curative treatment for people with thalassemia major (TM).This work aimed to study the impact of using low dose versus high dose anti thymocyte globulin (ATG (based conditioning regimen on the results of peripheral blood stem cell transplantation in children with βeta- TM. Methods: This comparative study was established on 40 patients with βeta-thalassemia major (Pesaro class II and/or III) who subjected to (HSCT)   from donor who is related. Our patients received the same myeloablative regimen. They were then categorized according to dose of ATG into two groups: group I (Busulfan/Cyclophosphamide/Low dose ATG-30 mg) and group II (Busulfan/Cyclophosphamide/High dose ATG-110 mg). Results: There was no association between both groups according to the clinical features, transplant related complications in both groups. There was a higher risk of mucositis and infections in high dose group. (P = 0.024 & P = 0.046; respectively). Patients in low dose group achieved faster neutrophil engraftment with median value of (14 days). No difference was found in the incidence of post-transplant viral reactivation, graft versus host disease in both groups. Conclusions: Pesaro II, III thalassemia patients can safely receive hematopoietic stem cell transplantation (HSCT) with low dose ATG-30 mg regimen and attain the same result.