Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin
BackgroundAnti-Thymocyte Globulin (ATG) is commonly used to prevent graft-versus-host disease (GVHD), but the optimal dosage and type of ATG remains to be determined.ObjectiveWe compared retrospectively the safety and efficacy outcomes of allogeneic transplantation using low-dose ATG-Fresenius (15mg...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1526513/full |
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| author | Itai Falicovich Boaz Nachmias Shlomo Elias Eran Zimran Adir Shaulov Polina Stepensky Batia Avni Sigal Grisariu |
| author_facet | Itai Falicovich Boaz Nachmias Shlomo Elias Eran Zimran Adir Shaulov Polina Stepensky Batia Avni Sigal Grisariu |
| author_sort | Itai Falicovich |
| collection | DOAJ |
| description | BackgroundAnti-Thymocyte Globulin (ATG) is commonly used to prevent graft-versus-host disease (GVHD), but the optimal dosage and type of ATG remains to be determined.ObjectiveWe compared retrospectively the safety and efficacy outcomes of allogeneic transplantation using low-dose ATG-Fresenius (15mg/kg) and ATG-Thymoglobulin (10mg/kg) for GVHD prevention.Study designNinety-eight patients were included, with 46 in the ATG-T group and 52 in the ATG-F group. The median age was 48 years in the ATG-T group (range 20-71) and 50 years in the ATG-F group (range 18-73). Baseline characteristics were similar, with slightly more HLA mismatched donors and single-agent cyclosporine GVHD prophylaxis use in the ATG-T group. Additionally, the ATG-F group had more myeloid leukemia and myelodysplastic syndrome patients, while the ATG-T group had more lymphoma patients.ResultsThe cumulative incidence of acute GVHD (aGVHD) grade II-IV and chronic GVHD (cGVHD) showed no significant differences. Multivariate analysis indicated that donor HLA mismatch influenced aGVHD risk significantly (p=0.005), and myeloablative conditioning increased cGVHD risk. Bacteremia and CMV reactivation rates were similar, but EBV DNA viremia was higher in the ATG-T group (22% vs. 8%, p=0.047), with one case of Post-Transplant Lymphoproliferative Disorder (PTLD) in the ATG-T group. Cumulative incidence of overall survival (OS), relapse incidence, non-relapse mortality (NRM) and GVHD free, Relapse free Survival (GRFS) did not significantly differ.ConclusionsThis study highlights the safety and efficacy of low-dose ATG-F compared to a relatively high dose ATG-T. Prospective studies are necessary to validate the safety and efficacy of low dose ATG-F for GVHD prevention. |
| format | Article |
| id | doaj-art-17642b75c3e54266b1f080267ec72ec6 |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj-art-17642b75c3e54266b1f080267ec72ec62025-01-27T06:40:46ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-01-011610.3389/fimmu.2025.15265131526513Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-ThymoglobulinItai Falicovich0Boaz Nachmias1Shlomo Elias2Eran Zimran3Adir Shaulov4Polina Stepensky5Batia Avni6Sigal Grisariu7Faculty of Medicine, The Hebrew University, Jerusalem, IsraelDepartment of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, IsraelBone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem, IsraelBone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem, IsraelDepartment of Hematology, Hadassah Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, IsraelBone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem, IsraelBone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem, IsraelBone Marrow Transplantation and Cancer Immunotherapy Department, Hadassah University Medical Center and Faculty of Medicine, The Hebrew University, Jerusalem, IsraelBackgroundAnti-Thymocyte Globulin (ATG) is commonly used to prevent graft-versus-host disease (GVHD), but the optimal dosage and type of ATG remains to be determined.ObjectiveWe compared retrospectively the safety and efficacy outcomes of allogeneic transplantation using low-dose ATG-Fresenius (15mg/kg) and ATG-Thymoglobulin (10mg/kg) for GVHD prevention.Study designNinety-eight patients were included, with 46 in the ATG-T group and 52 in the ATG-F group. The median age was 48 years in the ATG-T group (range 20-71) and 50 years in the ATG-F group (range 18-73). Baseline characteristics were similar, with slightly more HLA mismatched donors and single-agent cyclosporine GVHD prophylaxis use in the ATG-T group. Additionally, the ATG-F group had more myeloid leukemia and myelodysplastic syndrome patients, while the ATG-T group had more lymphoma patients.ResultsThe cumulative incidence of acute GVHD (aGVHD) grade II-IV and chronic GVHD (cGVHD) showed no significant differences. Multivariate analysis indicated that donor HLA mismatch influenced aGVHD risk significantly (p=0.005), and myeloablative conditioning increased cGVHD risk. Bacteremia and CMV reactivation rates were similar, but EBV DNA viremia was higher in the ATG-T group (22% vs. 8%, p=0.047), with one case of Post-Transplant Lymphoproliferative Disorder (PTLD) in the ATG-T group. Cumulative incidence of overall survival (OS), relapse incidence, non-relapse mortality (NRM) and GVHD free, Relapse free Survival (GRFS) did not significantly differ.ConclusionsThis study highlights the safety and efficacy of low-dose ATG-F compared to a relatively high dose ATG-T. Prospective studies are necessary to validate the safety and efficacy of low dose ATG-F for GVHD prevention.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1526513/fullATG FreseniusATG thymoglobulinallogenic bone marrow transplantationacute GVHDchronic GVHD |
| spellingShingle | Itai Falicovich Boaz Nachmias Shlomo Elias Eran Zimran Adir Shaulov Polina Stepensky Batia Avni Sigal Grisariu Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin Frontiers in Immunology ATG Fresenius ATG thymoglobulin allogenic bone marrow transplantation acute GVHD chronic GVHD |
| title | Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin |
| title_full | Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin |
| title_fullStr | Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin |
| title_full_unstemmed | Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin |
| title_short | Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin |
| title_sort | low dose atg fresenius for gvhd prophylaxis a comparative study with atg thymoglobulin |
| topic | ATG Fresenius ATG thymoglobulin allogenic bone marrow transplantation acute GVHD chronic GVHD |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1526513/full |
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