Antithymocyte globulin for prevention of graft-versus-host disease.
OBJECTIVE
This review aims to discuss current clinical trial using antithymocyte globulin in the context of hematopoietic stem cell transplantation. Published papers, as well as abstracts from European and American meetings, have been used together with original data.


RESULTS
The review shows that antithymocyte globulin is used frequently in Europe in the setting of unrelated or family mismatched donor transplants. This may not be the case for American centers, reluctant to introduce antithymocyte globulin possibly due to known side effects such as prolonged immune deficiency and increased incidence of infections, including life threatening Epstein-Barr virus-associated lymphoproliferative disorders. Results from few randomized trials show that antithymocyte globulin reduces acute and chronic graft-versus-host disease, and this is in keeping with results from retrospective analysis on large number of patients.


CONCLUSIONS
Several issues remain open, such as optimal dose, optimal timing with respect to infusion of stem cells and whether the commercially available agents have comparable effects. Prospective trials are needed to answer these important questions.
Bacigalupo
Andrea
A
Divisione Ematologia II, Ospedale San Martino, 16132 Genova, Italy. andrea.bacigalupo@hsanmartino.liguria.it
D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology*
D000961:Antilymphocyte Serum