ATG for GVHD – 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). It appears to not be very effective to treat already established disease. ATG treatment can produce objective responses in patients with aGVHD of up to 40%, but these responses do not result in long-term survival. A recent review (Neumeister) consluded: “Given the poor survival rates of patients treated with ATG for steroid-refractory GVHD, treatment with ATG as standard therapy should be reconsidered. Results in variosu study were contradictory. Patients with steroid-refractory GVHD should be enrolled in clinical study until there are data to support a standard salvage therapy.”
The authors of a recent British guideline discuss it as third line options and say: “The authors recognize that many centres have experience in using ATG for the treatment of acute GvHD but in view of thelack of evidence supporting its use suggest that the use of ATG is at the discretion of the treating physician. ”
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
Fiona L.Dignan n behalf of the Haemato-oncology Task Force of the British Committee for Standards in Haematology and the British Society for Blood and MarrowTransplantation et al, BCSH/BSBMTGuideline: Diagnosis and Management of Chronic Graft-versus-Host Disease chrome-extension://oemmndcbldboiebfnladdacbdfmadadm/http://www.bcshguidelines.com/documents/BCSH_Guideline_Chronic_GVHD_Diagnosis_and_Management_v1.pdf, 2012