Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
[en] Allogeneic hematopoietic stem cell transplantation is increasingly used as treatment for patients with life threatening blood diseases. Their curative potential is largely based on immune-mediated graft-versus-leukemia effects caused by donor T cells contained in the graft. Unfortunately, donor T cells are also the cause of graft-versus-host disease. The vast majority of HLA-matched allogeneic hematopoietic stem cell transplantations are nowadays carried out with peripheral blood stem cells (PBSC) as stem cell source. In comparison with bone marrows, PBSC contain more hematopoietic stem/progenitor cells but also one log more T cells. Consequently, the use of PBSC instead of bone marrow has been associated with faster hematological recovery and a lower risk of relapse in patients with advanced disease, but also with a higher incidence of chronic graft-versus-host disease. These observations have been the basis for several studies aimed at assessing the impact of immunoregulation with anti-thymocyte globulin (ATG) on transplantation outcomes in patients given HLA-matched PBSC from related or unrelated donors. After a brief introduction on ATG, this article reviews recent studies assessing the impact ATG on transplantation outcomes in patients given PBSC from HLA-matched related or unrelated donors as well as in recipients of grafts from HLA-haploidentical donors.
Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
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