International Journal of Hematology and Oncology 2023, Vol 33, Num 4 Page(s): 236-244
Antilymphocyte/Thymocyte Globulin for the Treatment of Steroid-Refractory Acute Graft-Versus-Host Disease: 20-Year Experience at a Single Center

Mehmet OZEN1, Sinem C. BOZDAG1, Guzin CAKMAK2, Pervin TOPCUOGLU1, Ayse H. EROGLU2, Mehmet GUNDUZ1, Onder ARSLAN1, Taner DEMIRER1, Hamdi AKAN1, Osman ILHAN1, Meral BEKSAC1, Gunhan GURMAN1, Muhit OZCAN1

1Ankara University Faculty of Medicine, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, TURKEY
2Ankara University Faculty of Medicine, Department of Internal Medicine, Ankara, TURKEY

Keywords: Antithymocyte globulin, Antilymphocyte globulin, Acute graft versus host disease
Although there is currently no consensus regarding the treatment of steroid-refractory acute graft-versus-host disease (GvHD) after hematopoietic stem cell transplantation (HSCT), antithymocyte globulin (ATG) is one of the most widely used immunosuppressive drugs in this setting. We retrospectively summarized our transplant center’s experience with 35 steroid-resistant acute GvHD patients who were treated with three different ATG preparations. Severe (grade III-IV) acute GvHD was observed either during the posttransplantation period (n= 32) or after donor lymphocyte infusion (n= 3). For secondary treatment of acute GvHD, rabbit Jurkat cell linereactive ATG (ATG Fresenius®) (n= 22), rabbit thymus cell-reactive ATG (Thymoglobulin®) (n= 9) or equine antilymphocyte globulin (ALG) (Lymphoglobulin®) (n= 4) was administered at a dose of 2-10 mg/kg/day for five consecutive days. The median time from the diagnosis of acute GvHD to the first day of infusion of ATG or ALG was 15 days (3-70 days). An overall response was observed in 15 patients (42%), with similar response rates among patients treated with any of the three ATG preparations. The overall survival (OS) of the patients did not increase in any treatment group, though the severity of GvHD and the disease status before HSCT were shown to negatively impact OS. Although responses could be achieved in steroid-refractory acute GvHD using rabbit or horse ATG, survival rates did not increase because of high mortality rates due to infection during treatment.