title: Anti-thymocyte globulins for post-transplant graft-versus-host disease prophylaxis-A systematic review and meta-analysis.
abstract: BACKGROUND
  Despite advances made in allogeneic hematopoietic stem cell transplantation (alloSCT), graft versus host disease (GvHD) remains a major problem. The main strategy to combat GvHD is prophylaxis and ATG plays a major role in this arena. Conflicting reports on the effectiveness of ATG on GvHD prevention prompted us to address this question by means of a systematic review and meta-analysis.
  
  
  METHODS
  Six prospective randomized controlled trials (RCT) comparing the addition of ATG to standard immunosuppressive regimen as GvHD prophylaxis were analyzed. All ATG preparations were considered but homogeneity in type of preparation and dosage had to be observed within each trial.
  
  
  RESULTS
  Our meta-analysis reveals that the incidence of grade II-IV GvHD was significantly lower in patients receiving ATG. Addition of ATG had no impact on overall survival, relapse or non-relapse mortality.
  
  
  CONCLUSIONS
  Based on the current level of the data analyzed in this systematic review, we cannot conclude a general recommendation for the use of ATG for GvHD prophylaxis in alloSCT. In patients who are at high risk for severe GvHD it should be considered individually. However, due to the heterogeneity of the analyzable studies it seems likely that future studies might change the results of the pooled data of this meta-analysis. In order to improve the current level of data, further randomized studies in this topic are therefore urgently warranted.
authors.affiliation: Department I of Internal Medicine, Stem Cell Transplantation Program, University Hospital of Cologne, Cologne, Germany. Electronic address: sebastian.theurich@uk-koeln.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Theurich
authors.forename: Hans
authors.initials: H
authors.lastname: Fischmann
authors.forename: Geothy
authors.initials: G
authors.lastname: Chakupurakal
authors.forename: Alexander
authors.initials: A
authors.lastname: Shimabukuro-Vornhagen
authors.forename: Jens M
authors.initials: JM
authors.lastname: Chemnitz
authors.forename: Udo
authors.initials: U
authors.lastname: Holtick
authors.forename: Achim
authors.initials: A
authors.lastname: Rothe
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.forename: Nicole
authors.initials: N
authors.lastname: Skoetz
authors.forename: Michael
authors.initials: M
authors.lastname: von Bergwelt-Baildon
mesh_terms: D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016017:Odds Ratio; D011292:Premedication; D016032:Randomized Controlled Trials as Topic; D014184:Transplantation, Homologous
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents
keywords: ATG; Allogeneic stem cell transplantation; Anti-thymocyte globulins; Bone marrow transplantation; Graft-versus-host disease; GvHD; Meta-analysis; Systematic review