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ATG in GVHD prophylaxis: are we back to the future?

Acute and chronic graft-versus-host disease (GVHD) remains the major cause of mortality and morbidity after allogeneic stem cell transplantation. Treatment of established GVHD remains suboptimal, and prevention is clearly the favored approach, ideally without impairing pathogen- and leukemia-specific immunity. The administration of antithymocyte globulin (ATG) before transplantation reduces severe GVHD; as discussed by Andrea Bacigalupo in this issue, it has become a standard of care in Europe, at least when alternative donors are used. Natasha Kekre and Joseph Antin from North America argue that the jury is still out: ATG confers no survival benefit, and advantages with regard to reductions in GVHD must be balanced against an individual patient’s risk of relapse and infection. It is 2017, and here we are discussing whether we should be using polyclonal antibody preparations raised in horses and rabbits for GVHD prophylaxis. What do you think? Join the conversation.

Copyright © 2017 American Society for Hematology

Acute and chronic graft-versus-host disease (GVHD) remains the major cause of mortality and morbidity after allogeneic stem cell transplantation.