EBMT consensus recommendations for ATG/ATLG in allo-HSCT

Best practice recommendations from the European Society for Blood and Marrow Transplantation (EBMT) Practice Harmonisation and Guidelines Committee for the use of anti-thymocyte globulin (ATG) and anti-T-lymphocyte globulin (ATLG) for hematological malignancies in allogeneic hematopoietic stem cell transplantation (allo-HSCT) to reduce the risk of graft-versus-host disease (GvHD) were published in Bone Marrow Transplantation by Battipaglia et al.

Key data: The EBMT recommends ATG/ATLG incorporation in matched related and unrelated donor allo-HSCT for GvHD prophylaxis. Selection between ATG or ATLG therapy can be guided by institutional protocols, availability, and clinician preference. Personalization of treatment, particularly when guided by pharmacokinetic (PK) and pharmacodynamic (PD) modeling, may improve efficacy and safety in both adult and pediatric patients. It is not recommended to switch between types of ATG/ATLG if a second allo-HSCT is required. Mitigation or prevention of side effects is recommended for both infusion-related reactions and long-term complications.

Key learning: Standardization across treatment centers is essential for providing personalized dosing of ATG and ATLG. Further research and real-world data are required to validate and improve current practices.