title: The impact of antithymocyte globulin on short-term toxicity after allogeneic stem cell transplantation.
abstract: Antithymocyte globulin (ATG) is commonly used in allogeneic haematopoietic stem cell transplantation (HSCT). Little information is available, however, as to the optimal protocol for use and the side-effects occurring if ATG is administered in high daily doses (10-30 mg/kg). We report our experience with ATG Fresenius (ATG-F) in conditioning for allogeneic HSCT. During a period of 3 days, 47 patients received doses between 10 and 30 mg/kg either over 4 h preceded by 1-1.5 mg/kg prednisolone 30 min before the start of ATG-F (protocol A) or alternatively, over 12 h with 3-4 mg/kg prednisolone being administered before and 6 h after start of ATG (protocol B). During treatment with ATG-F, the side-effects observed included inflammation, disseminated intravascular coagulation, hyperdynamic circulation and renal dysfunction. Although these complications caused substantial morbidity, they were reversible within a few days. Side-effects were significantly more severe in patients treated according to protocol A than in those treated according to protocol B. As prolonged infusion of ATG-F does not reduce T cell clearance due to the long half-life of ATG-F, and since less cytokine release during conditioning might have beneficial long-term effects, we recommend administering ATG-F over 12 h preceded by high-dose steroid treatment.
authors.affiliation: Medizinische Klinik III-Grobetahadern, Klinikum der Ludwig-Maximilians-Universität, München, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Pihusch
authors.forename: E
authors.initials: E
authors.lastname: Holler
authors.forename: D
authors.initials: D
authors.lastname: Mühlbayer
authors.forename: P
authors.initials: P
authors.lastname: Göhring
authors.forename: O
authors.initials: O
authors.lastname: Stötzer
authors.forename: M
authors.initials: M
authors.lastname: Pihusch
authors.forename: E
authors.initials: E
authors.lastname: Hiller
authors.forename: H-J
authors.initials: HJ
authors.lastname: Kolb
mesh_terms: D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000633:toxicity*; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced; D004341:Drug Evaluation; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000633:toxicity*; D007249:Inflammation / Q000139:chemically induced; D007674:Kidney Diseases / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011239:Prednisolone