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ORIGINAL RESEARCH article

Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1526513
This article is part of the Research Topic Balancing Alloantigen-Induced Immune Responses and Anti-tumor Immunity in Transplantation View all 7 articles

Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin.

Provisionally accepted
Itay Falicovich Itay Falicovich Boaz Nachmias Boaz Nachmias *Shlomo Elias Shlomo Elias Eran Zimran Eran Zimran Adir Shaulov Adir Shaulov Polina Stepensky Polina Stepensky Batia Avni Batia Avni *Sigal Grisariu Sigal Grisariu
  • Hadassah University Medical Center and Faculty of Medicine, the Hebrew University, Jerusalem, Israel

The final, formatted version of the article will be published soon.

    Background: Anti-Thymocyte Globulin (ATG) is commonly used to prevent graft-versus-host disease (GVHD), but the optimal dosage and type of ATG remains to be determined. Objective: We compared retrospectively the safety and efficacy outcomes of allogeneic transplantation using low-dose ATG-Fresenius (15mg/kg) and ATG-Thymoglobulin (10mg/kg) for GVHD prevention. Study design: Ninety-eight patients were included, with 46 in the ATG-T group and 52 in the ATG-F group. The median age was 48 years in the ATG-T group (range 20-71) and 50 years in the ATG-F group (range 18-73). Baseline characteristics were similar, with slightly more HLA mismatched donors and single-agent cyclosporine GVHD prophylaxis use in the ATG-T group. Additionally, the ATG-F group had more myeloid leukemia and myelodysplastic syndrome patients, while the ATG-T group had more lymphoma patients Results: The cumulative incidence of acute GVHD (aGVHD) grade II-IV and chronic GVHD (cGVHD) showed no significant differences. Multivariate analysis indicated that donor HLA mismatch influenced aGVHD risk significantly (p=0.005), and myeloablative conditioning increased cGVHD risk. Bacteremia and CMV reactivation rates were similar, but EBV DNA viremia was higher in the ATG-T group (22% vs. 8%, p=0.047), with one case of Post-Transplant Lymphoproliferative Disorder (PTLD) in the ATG-T group. Cumulative incidence of overall survival (OS), relapse incidence, non-relapse mortality (NRM) and GVHD free, Relapse free Survival (GRFS) did not significantly differ. Conclusions: This study highlights the safety and efficacy of low-dose ATG-F compared to a relatively high dose ATG-T. Prospective studies are necessary to validate the safety and efficacy of low dose ATG-F for GVHD prevention.

    Keywords: ATG fresenius, atg thymoglobulin, Allogenic bone marrow transplantation, acute GVHD, chronic GVHD

    Received: 11 Nov 2024; Accepted: 06 Jan 2025.

    Copyright: © 2025 Falicovich, Nachmias, Elias, Zimran, Shaulov, Stepensky, Avni and Grisariu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Boaz Nachmias, Hadassah University Medical Center and Faculty of Medicine, the Hebrew University, Jerusalem, Israel
    Batia Avni, Hadassah University Medical Center and Faculty of Medicine, the Hebrew University, Jerusalem, Israel

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