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Polyclonal anti-thymocyte globulins for the prophylaxis of graft-versus-host disease after allogeneic stem cell or bone marrow transplantation in adults


Theurich, s., et al

Subject Keywords: To assess the effect of ATG used for the prevention of graft-versus-host disease (GVHD) in patients undergoing allogeneic HSCT with regard to overall survival, incidence and severity of acute and chronic GVHD, incidence of relapse, incidence of infectious complications, non-relapse mortality, early mortality within 100 days of transplantation, progression-free survival, quality of life and adverse events
Type: Article
Region: International (other)

Allogeneic haematopoietic (blood) stem cell transplantation (HSCT) is a potentially curative therapeutic option for a variety of malignant and some non-malignant haematological (blood-related) diseases. For this therapy, blood stem cells are transferred from a healthy person who has compatible tissue markers, so-called human leukocyte antigen (HLA) markers, to a matched recipient. Even though the donor and the recipient are matched concerning these markers, immune cells that are part of the transferred cells ('the graft') are prone to recognise tissues of the recipient ('the host') as being to some extent incompatible or foreign, which then can induce inflammation ('graft-versus-host-disease' or 'GVHD'). GVHD typically involves the skin, the gastrointestinal tract and the liver. GVHD is divided into acute and chronic forms based on the clinical features and the time of occurrence after transplantation. In order to prevent this potentially life-threatening condition, reactive immune cells can be depleted in the recipient by administering antibodies which are directed against them. These antibodies are called anti-thymocyte globulins (ATG) and are derived from animals which were immunised with human thymocytes or T-cells. Different types of ATG have been used for decades to decrease the occurrence and severity of GVHD but they bear the risk of severe side effects such as increased infection rates or the risk of disease relapse. Also, severe side effects such as allergic reactions or serum sickness with shortness of breath and fever, blood coagulation disturbances or liver failure can harm the patient during the infusion of ATG. So far, no systematic analysis of the advantages and disadvantages of the use of ATG has been done.

In this systematic review, we included six randomised controlled trials comprising 568 adult patients. In summary, we found evidence that the addition of ATG reduced the occurrence of only the severe forms (grade II to IV) of acute GVHD with a number needed to treat (NNT) of 8 concerning grade II to IV acute GVHD and a NNT of 7 concerning acute GVHD grade III to IV. This means that eight or seven patients have to be treated with ATG, respectively, in order to prevent one case of severe acute GVHD. However, neither overall survival nor the overall occurrence rate of acute GVHD was improved by the use of ATG. Moreover, we did not find a difference between ATG treated patients and those who did not receive ATG regarding relapse of the underlying disease or non-relapse mortality. The effect of ATG on quality of life after stem cell transplantation, which would be an important issue, has not been evaluated in randomised studies so far.



Suggested citation:

Theurich, s., et al. (2012) Polyclonal anti-thymocyte globulins for the prophylaxis of graft-versus-host disease after allogeneic stem cell or bone marrow transplantation in adults [Online]. Available from: [Accessed: 22nd August 2019].


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