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ATG or no ATG? – survey of clinical practice in EBMT centers on behalf of the Transplant Complications Working Party of EBMT

Bone Marrow Transplantation volume 58, pages 337–339 (2023)Cite this article

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Immunoregulation by administration of anti-thymocyte globulin (ATG) in allogeneic hematopoietic cell transplantation (alloHCT) is believed to help maintain the balance between graft-versus-malignancy/leukemia (GVL), the relapse incidence (RI), and severe graft-versus-host disease (GVHD) [1, 2]. Currently, two brands of rabbit (r)ATG: ATG-T (thymoglobulin) and ATG-F (ATG Fresenius/Neovii) are available but prospective studies comparing the two brands are lacking. The indications for rATG use and dosing in various transplant settings have changed over time [3,4,5,6].

We evaluated the current real-world clinical practice concerning rATG use in the prevention of GVHD after alloHCT in patients with hematological malignancies, using the survey method (Supplementary Materials) in 143/340 (42%) European Society for Blood and Marrow Transplantation (EBMT) centers. Most centers (97%) declared the use of ATG-containing GVHD prophylaxis in alloHCT. When bone marrow is the source of hematopoietic cells, 15.3% of the centers declared that they did not use ATG. Most centers (65%) used ATG both in the unrelated donor (UD) and matched sibling donor (MSD) settings. In the MSD-alloPBSCT setting, 33% of responders did not consider ATG, 36% of the centers used ATG in all cases, while 31% used it only in patients with a high risk of GVHD (female donors for male patients- 29%, female donors after pregnancy- 23%, donors aged >50 years- 20%, patients aged >50 years- 10%). Most centers (88%) declared the use of ATG regardless of the intensity of the conditioning regimen.

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Fig. 1: ATG-F and ATG-T doses in various transplantation settings.

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Acknowledgements

We express our gratitude to all participating EBMT centers for their contribution to the survey. We also thank all members of the transplant teams for their devotion to patients.

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Author notes

  1. These authors contributed equally: Agnieszka Piekarska, Anna Czyz.

Authors and Affiliations

  1. Department of Hematology and Transplantology, Medical University of Gdansk and University Clinical Center, Gdansk, Poland

    Agnieszka Piekarska

  2. Department of Hematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland

    Anna Czyz

  3. EBMT- Transplant Complications Working Party; Saint Antoine Hospital, Sorbonne University, Paris, France

    Christophe Peczynski, Pascale Ambron & Emmanuelle Polge

  4. RM Gorbacheva Research Institute, Pavlov University, St Petersburg, Russian Federation

    Ivan Moiseev

  5. Department of Hematology, University Hospitals Leuven and Department of Public Health and Primary Care, ACCENT VV, KU Leuven - University of Leuven, Leuven, Belgium

    Helene Schoemans

  6. Charité – Department of Hematology, Oncology and Tumorimmunology, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

    Olaf Penack

  7. School of Medicine, University Hospital Centre Zagreb and University of Zagreb, Zagreb, Croatia

    Zinaida Peric

  8. Department of Hematology, Transplantation and Internal Medicine, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland

    Grzegorz W. Basak

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  1. Agnieszka Piekarska
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  10. Grzegorz W. Basak
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Contributions

AP: concept of a study, preparation of the survey, analysis and interpretation of the results, reference search, writing a manuscript, tables and figures; AC: concept of a study, preparation of the survey, analysis and interpretation of the results, reference search, writing a manuscript; PA: conducting of the survey, preparation of data results; CP: conducting of the survey, preparation of data results, analysis of the results; EP: conducting of the survey, preparation of data results; IM: critical revision of the manuscript; HS: critical revision of the manuscript; OP: drafting and critical revision of the manuscript; ZP: critical revision of the manuscript, GB: drafting and critical revision of the manuscript, supervision. All authors approved the final version.

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Correspondence to Agnieszka Piekarska.

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Piekarska, A., Czyz, A., Peczynski, C. et al. ATG or no ATG? – survey of clinical practice in EBMT centers on behalf of the Transplant Complications Working Party of EBMT. Bone Marrow Transplant 58, 337–339 (2023). https://doi.org/10.1038/s41409-022-01889-y

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