ATG in allogeneic SCT to prevent GVHD – pro
Using ATG to treat, and at this point to prevent GVHD is somewhat controversial, since it can compromise graft0versus-leukemai effect and incrase infectious complications. his strategy again offers a reduction in acute and chronic GVHD, but does not improve survival because of the increased infection-related deaths. Although ATG has been compared with standard GVHD prophylaxis strategies that include a calcineurin inhibitor and methotrexate, it is unclear if ATG is a better prophylactic strategy in comparison with these other T-cell depletion strategies. That stated, ATG was initally being avoided in this case, and other immnosuppresies were not sufficient for GVHD.
Recently, a consensus-based recommendation by an international expert panel ( BOnifazi et al)suggested the use of 30 mg/kg and 60 mg/kg of ATLG for sibling and unrelated MAC transplants, respectively, or 4.5–7.5 mg/kg of ATG ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD.
Natasha Kekre, Joseph H. Antin, TG in allogeneic stem cell transplantation: standard of care in 2017? Counterpoint. Blood Advances Volume 1, Issue 9
March 28 2017.
Bonifazi F, Rubio MT, Bacigalupo A, Boelens JJ, Finke J, Greinix H, Mohty M, Nagler A, Passweg J, Rambaldi A, Socie G, Solano C, Walker I, Barosi G, Kröger N (2020) Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel. Bone Marrow Transplant 55:1093–1102
Butera, S., Cerrano, M., Brunello, L. et al. Impact of anti-thymocyte globulin dose for graft-versus-host disease prophylaxis in allogeneic hematopoietic cell transplantation from matched unrelated donors: a multicenter experience. Ann Hematol 100, 1837–1847 (2021). https://doi.org/10.1007/s00277-021-04521-z