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Personalizing rabbit anti-thymocyte globulin therapy for prevention of graft-versus-host disease after allogeneic hematopoietic cell transplantation: is there an optimal dose?

Bone Marrow Transplantation volume 55, pages 505–522 (2020)Cite this article

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Abstract

The efficacy of anti-thymocyte globulin (ATG) as prophylaxis for graft-versus-host disease (GVHD) has been investigated by many clinical studies over the past decade, including some randomized controlled trials. Intriguingly, although ATG is commonly used as prophylaxis for GVHD, there is still controversy about the optimal dose of ATG for prophylaxis of GVHD after allogeneic hematopoietic cell transplantation (allo-HCT). Indeed, the dose and formulation of ATG, as well as the degree of clinical benefit, has varied among studies, which makes it difficult to fully determine the clinical benefit of ATG. The aim of this review is to summarize the information regarding the optimal ATG dose of each formulation according to stem cell source, and to discuss how best to determine the personalized optimal dose of ATG in each allo-HCT recipient.

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Acknowledgements

This study was supported by Health, Labour, and Welfare Science Grants for Research on Measures for Rare and Intractable Diseases from the Japanese Government.

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Author notes

  1. These authors contributed equally: Takafumi Shichijo, Shigeo Fuji

Authors and Affiliations

  1. Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University Faculty of life Sciences, Kumamoto, Japan

    Takafumi Shichijo

  2. Laboratory of Virus Control, Institute for Frontier Life and Medical Sciences, Kyoto University, Kyoto, Japan

    Takafumi Shichijo

  3. Department of Hematology, Osaka International Cancer Institute, Osaka, Japan

    Shigeo Fuji

  4. Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel

    Arnon Nagler

  5. Service d’Hématologie Clinique et thérapie cellulaire and EBMT Paris Study Office, Saint Antoine Hospital, INSERM UMR 938 and Sorbonne University, Paris, France

    Abdulhamid Bazarbachi & Mohamad Mohty

  6. Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

    Bipin N. Savani

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  1. Takafumi Shichijo
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  2. Shigeo Fuji
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Contributions

TS, SF, AN, AB, MM, and BNS wrote the paper.

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Correspondence to Shigeo Fuji.

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Shichijo, T., Fuji, S., Nagler, A. et al. Personalizing rabbit anti-thymocyte globulin therapy for prevention of graft-versus-host disease after allogeneic hematopoietic cell transplantation: is there an optimal dose?. Bone Marrow Transplant 55, 505–522 (2020). https://doi.org/10.1038/s41409-019-0643-9

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