Objective: To look into the security of a second allogeneic hematopoietic stem cell transplantation (allo-HSCT) using rabbit anti-human thymocyte immunoglobulin (rATG) . Methods: Twenty-seven patients who used rATG in the first and second allo-HSCT at the Institute of Hematology, Peking University were enrolled in the study. Experienced toxicities associated with the conditioning protocol within 10 days (-5 d to +3 d) following the beginning of the rATG application, including fever, diarrhea, arrhythmia, reduced blood pressure, liver damage, seizures, and other problems. Results: The overall incidence of conditioning regimen early adverse reactions during the first transplantation and the second allo-HSCT conditioning regimen was 96.3% and 77.8% (P=0.043) . Fever rates were 81.5% and 63.0% (P=0.129) , diarrhea rates were 59.3% and 25.9% (P=0.013) , liver damage rates were 22.2% and 25.9% (P=0.75) , and the rates of other events (cardiac arrhythmia, low blood pressure, and epilepsy) were 3.7% and 18.5% (P=0.083) . Adverse reactions that occurred during both the first and second course of rATG applications have been improved with symptomatic treatment, and no treatment interruptions occurred. Conclusion: Reusing rATG in a second transplant was risk-free and did not result in higher early toxicities.
目的： 探讨兔抗人胸腺细胞免疫球蛋白（rATG）第二次应用于异基因造血干细胞移植（allo-HSCT）的安全性。 方法： 回顾性分析2008年4月至2021年8月在北京大学血液病研究所先后接受两次allo-HSCT且预处理方案均使用rATG的27例患者。观察自rATG应用开始10 d内（移植前5 d至移植后3 d）预处理相关不良反应（发热、腹泻、心律失常、血压下降、肝损伤、癫痫等）在首次、二次应用中的发生情况，评价rATG在二次allo-HSCT中的安全性。 结果： 首次、二次allo-HSCT预处理期间自开始使用rATG至移植后3 d，不良反应发生率分别为96.3%、77.8%（P＝0.043），发热发生率分别为81.5%、63.0%（P＝0.129），腹泻发生率分别为59.3%、25.9%（P＝0.013），肝功能异常发生率分别为22.2%、25.9%（P＝0.750），其他事件（心律失常、血压下降、癫痫）的发生率分别为3.7%、18.5%（P＝0.083）。两次rATG应用期间发生的不良反应经对症治疗后均好转，无治疗中断发生。此外，在首次移植和二次移植应用rATG当天患者淋巴细胞计数的均数分别为0.5×10(9)/L、0.3×10(9)/L（P＝0.038）。 结论： rATG用于第二次allo-HSCT没有增加预处理早期不良反应的发生率。.
Keywords: Adverse reactions; Allogeneic hematopoietic stem cell transplantation; Antithymocyte globulin; Conditioning regimen.