Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.

摘要

Allogeneic hematopoietic stem cell transplantation is increasingly used as treatment for patients with life threatening blood diseases. Their curative potential is largely based on immune-mediated graft-versus-leukemia effects caused by donor T cells contained in the graft. Unfortunately, donor T cells are also the cause of graft-versus-host disease. The vast majority of HLA-matched allogeneic hematopoietic stem cell transplantations are nowadays carried out with peripheral blood stem cells (PBSC) as stem cell source. In comparison with bone marrows, PBSC contain more hematopoietic stem/progenitor cells but also one log more T cells. Consequently, the use of PBSC instead of bone marrow has been associated with faster hematological recovery and a lower risk of relapse in patients with advanced disease, but also with a higher incidence of chronic graft-versus-host disease. These observations have been the basis for several studies aimed at assessing the impact of immunoregulation with anti-thymocyte globulin (ATG) on transplantation outcomes in patients given HLA-matched PBSC from related or unrelated donors. After a brief introduction on ATG, this article reviews recent studies assessing the impact ATG on transplantation outcomes in patients given PBSC from HLA-matched related or unrelated donors as well as in recipients of grafts from HLA-haploidentical donors.