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Addition of ATG to standard prophylaxis reduces incidence of acute and chronic GvHD
By Ella Dixon
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Addition of ATG to standard GvHD prophylaxis has been shown to reduce the incidence of acute and chronic GvHD; however, it may increase the risk of relapse.1 A retrospective, real-world, cohort study published by Bai et al.1 in Acta Haematologica compared ATG + standard GvHD prophylaxis (CSA + MTX) with the standard prophylaxis alone. The study included 210 patients undergoing unrelated donor allogeneic HSCT, of which 140 received ATG + CSA + MTX and 70 received CSA + MTX alone. The primary outcomes of the study were cumulative incidence of acute and chronic GvHD at 1- and 2-years post-HSCT.1
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The incidence of any grade aGvHD was significantly lower in patients treated with ATG vs those without (51.4% vs 70%; p = 0.010). The incidence of chronic GvHD at 1-year (36.4% vs 62.9%; p < 0.001) and 2-years (40.0% vs 65.7%; p < 0.001) post-allo-HSCT was lower in the ATG vs non-ATG group. |
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GvHD-related mortality was lower in the ATG group (4.3% vs. 18.5%). However, the 2-year OS was similar between the ATG and non-ATG groups (65.0% vs 64.3%). In the ATG group, the rate of relapse post-HSCT was higher at 1-year (24.3% vs 14.3%; p = 0.09) and 2-years (31.4% vs 17.1%; p = 0.216) compared with the non-ATG group. |
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ATG use did not increase the overall incidence of cytomegalovirus (p = 1.000) or Epstein-Barr virus reactivation (p = 0.104), although the number of patients requiring hospital admissions due to viral reactivations was higher in the ATG vs non-ATG groups (7 vs 0). |
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Addition of ATG to standard GvHD prophylaxis effectively reduced GvHD incidence and severity, potentially improving GvHD-free survival. Tailoring ATG dosing and timing may optimize outcomes while mitigating relapse risk in patients undergoing allo-HSCT. |
Abbreviations: aGvHD, acute graft-versus-host disease; allo-HSCT, allogeneic hematopoietic stem cell transplant; ATG, anti-thymocyte globulin; CSA, cyclosporine A; GvHD, graft-versus-host disease; MTX, methotrexate.
- Bai N, Limvorapitak W, Henderson R, et al. Real-world impact of routine addition of anti-thymocyte globulin to standard GvHD prophylaxis in myeloablative unrelated donor transplants: Important gains in graft vs host disease prevention though no difference in overall survival. Acta Hematol. 2024. Online ahead of print. DOI: 10.1159/000541071
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