Determining the best premedication regimen to prevent rabbit anti-human thymocyte globulin infusion-associated reactions: A retrospective study comparing two hematopoietic stem cell transplant centers
Notice bibliographique
Résumé
BACKGROUND: Thymoglobulin® (ATG), a rabbit anti-human thymocyte globulin, is used in allogeneic hematopoietic stem cell transplantation (HSCT) mainly to prevent the development of graft-versus-host disease (GVHD). Three doses (ATG1, ATG2, and ATG3) are administered on separate days, apart from the graft day. Since infusion-associated reactions (IAR) are frequent, patients were treated with acetaminophen, antihistamine, and corticosteroids (CS) as premedication (PR); however, the best PR regimen remains to be defined. METHODS: The study compared the incidence and severity of IAR related to ATG according to the different PR therapy. This descriptive retrospective cohort study included patients receiving ATG in two HSCT transplant centers (Hospitals A and B). The data cut-off was in March 2020, but the period of interest was different between the two hospitals to balance the two groups. Four PR regimens were compared, one from Hospital A (PR-A) and three from Hospital B (PR-B1, B2, and B3), which have changed twice in the last decade. Along with PR therapy, the indication and method of administration of ATG also differed between hospitals. RESULTS: A total of 132 patients were included from May 2011 to March 2020. Groups PR-A, B1, B2, and B3 had, respectively, 61, 22, 26, and 23 patients. Of them, 115 (87 %) had at least one IAR, and 86 (65 %) had at least one severe IAR during any ATG infusions. ATG3 had the lowest incidence of IAR (39 %), and it seemed better tolerated when given after graft infusion than before (32 % vs. 46 %, respectively; p = 0.11). Almost three-quarters of patients had at least one IAR that occurred after the end of an ATG infusion, but there was less IAR with PR-B3 protocol where acetaminophen and diphenhydramine were regularly administered beyond ATG infusion. Hospital A used a progressive rate of infusion, but early IAR was seen compared to Hospital B (p = 0.03), where a fixed rate was used. No direct association was found between the CS dose received and IAR incidence (p = 0.21) or severity (p = 0.61). However, there was a recurrent signal for less severe IAR in the PR-B3 group compared to its predecessors, B1 and B2 groups (p = 0.12), and the key difference was an increased CS dose. The mean total CS therapy received was nearly double at Hospital A compared with Hospital B (1182 vs. 692 mg prednisone equivalent; p < 0.01). Fungal infection rate was higher in Hospital A compared to Hospital B (33 % vs. 13 %; p < 0.01). The infection rate correlated with a higher dose of CS received on days of ATG therapy (p < 0.01). CONCLUSION: ATG3 given the day after HSCT appears to play a key role in reducing the incidence and severity of IAR. Infusion over six hours at a fixed rate was safe. Frequent, regular, and extended doses of acetaminophen and antihistamines beyond ATG infusion appear useful. Increasing CS doses led to IAR reduction, but this correlated with an increased infection rate.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».