Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel

• Published in: Bone marrow transplantation (Basingstoke) Vol. 55; no. 6; pp. 1093 - 1102
• Main Authors: Bonifazi, Francesca, Rubio, Marie-Thérèse, Bacigalupo, Andrea, Boelens, Jaap Jan, Finke, Jürgen, Greinix, Hildegard, Mohty, Mohamad, Nagler, Arnon, Passweg, Jakob, Rambaldi, Alessandro, Socie, Gérard, Solano, Carlos, Walker, Irwin, Barosi, Giovanni, Kröger, Nicolaus
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2020; Nature Publishing Group
• Subjects: 692/699; 692/699/249; Animals; Antilymphocyte serum; Antilymphocyte Serum - therapeutic use; Antithymocyte globulin; Biotechnology industry; Bone marrow; Cell Biology; Conditioning; Consensus; Delphi method; Globulins; Graft versus host disease; Graft vs Host Disease - prevention & control; Graft-versus-host reaction; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Histocompatibility antigen HLA; Human health and pathology; Immunology; Immunotherapy; Internal Medicine; Life Sciences; Lymphocytes; Lymphocytes T; Medical colleges; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local; Peripheral blood; Pharmaceutical industry; Prophylaxis; Public Health; Rabbits; Stem cell transplantation; Stem Cells; T cells; Thymocytes; Transplantation; Transplantation Conditioning; Transplants & implants; Vaccination; France; Canada; United States
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-020-0792-x

This collaborative initiative aimed to provide recommendations on the use of polyclonal antithymocyte globulin (ATG) or anti-T lymphocyte globulin (ATLG) for the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). A comprehensive review of articles released up to October, 2018 was performed as a source of scientific evidence. Fourteen clinically relevant key questions to the domains indication, administration, and post-transplant management were developed and recommendations were produced using the Delphi technique involving a Panel of 14 experts. ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD. ATG/ATLG was also recommended prior to HLA-identical sibling peripheral HSCT with good but lesser bulk of evidence. In reduced intensity or nonmyeloablative conditioning regimens, ATG/ATLG was deemed appropriate to reduce the incidence of acute and chronic GvHD, but a higher risk of relapse should be taken into account. Recommendations regarding dose, application, and premedication were also provided as well as post-transplant infectious prophylaxis and vaccination. Overall, these recommendations can be used for a proper and safe application of polyclonal ATG/ATLG to prevent GvHD after allogeneic HSCT.