ATG for graft versus host disease – pro

Severe acute graft-versus-host disease (GVHD) is one of the major complications after haematopoietic stem-cell transplantation (HSCT). Treatment of severe GVHD is difficult and the condition is often fatal. One proposed method of improving the therapy is to include anti-thymocyte globulin (ATG). ATG is being actively studied for prophylaxis of GVHD after allogeneic transplantation, f. e., the phase II study Sirolimus, Tacrolimus, and Antithymocyte Globulin in Preventing Graft-Versus-Host Disease in Patients Undergoing a Donor Stem Cell Transplant For Hematological, NCT00589563.

However, it appears to not be very effective to treat already established disease. ATG treatment can produce objective responses in patients with aGVHD, but these responses do not result in long-term survival. A recent review consluded: “Given the poor survival rates of patients treated with ATG for steroid-refractory GVHD, treatment with ATG as standard therapy should be reconsidered. Patients with steroid-refractory GVHD should be enrolled in clinical study until there are data to support a standard salvage therapy.”

Neumeister P, Zinke W, Sill H, Linkesch W: Treatment of severe acute graft-versus-host disease with anti-thymocyte globulin Clinical transplantation   ISSN 0902-0063
2001, vol. 15, no3, pp. 147-153 (48 ref.)

S . Arai Poor outcome in steroid-refractory graft-versus-host disease with antithymocyte globulin treatment .  Biology of Blood and Marrow Transplantation , Volume 8 , Issue 3 , Pages 155 – 160, 2002

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