title: Efficacy of antithymocyte globulin for allogeneic hematopoietic cell transplantation: a systematic review and meta-analysis.
abstract: The efficacy of rabbit antithymocyte globulin (ATG) for the prevention of graft-versus-host disease (GVHD) has been evaluated in several randomized control trials, but the results show some discrepancies. Therefore, we performed a systematic review and meta-analysis covering the latest RCTs including six trials (total 845 patients). The incidence of acute and chronic GVHD was significantly lower in the ATG arms (risk ratio, 0.75 and 0.54, respectively). No significant differences were found regarding overall survival, the incidence of relapse, and non-relapse mortality; however, the incidence of cytomegalovirus and Epstein-Barr virus reactivation increased (risk ratio, 1.25 and 1.33), and neutrophil engraftment was significantly delayed (median, 2.66 days). In conclusion, rabbit ATG should be beneficial as a GVHD prophylaxis in addition to conventional regimens, with close monitoring of virus reactivation and enough attention to delayed engraftment. Studies comparing the timing and dosage of ATG are essential to determine the suitable prophylactic regimens.
authors.affiliation: a Department of Hematology and Oncology, Graduate School of Medicine , Kyoto University , Kyoto , Japan.|b Laboratory of Host Defenses , National Institute of Allergy and Infectious Diseases, National Institutes of Health , Bethesda , MD , USA.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Arai
authors.affiliation: a Department of Hematology and Oncology, Graduate School of Medicine , Kyoto University , Kyoto , Japan.
authors.forename: Tomoyasu
authors.initials: T
authors.lastname: Jo
authors.affiliation: a Department of Hematology and Oncology, Graduate School of Medicine , Kyoto University , Kyoto , Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsui
authors.affiliation: a Department of Hematology and Oncology, Graduate School of Medicine , Kyoto University , Kyoto , Japan.
authors.forename: Tadakazu
authors.initials: T
authors.lastname: Kondo
authors.affiliation: a Department of Hematology and Oncology, Graduate School of Medicine , Kyoto University , Kyoto , Japan.
authors.forename: Akifumi
authors.initials: A
authors.lastname: Takaori-Kondo
mesh_terms: D000208:Acute Disease; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D009026:Mortality; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011788:Quality of Life; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007155:Immunologic Factors
keywords: Graft-versus-host disease; allogeneic hematopoietic cell transplantation; antithymocyte globulin; meta-analysis