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Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel.

Abstract

This collaborative initiative aimed to provide recommendations on the use of polyclonal antithymocyte globulin (ATG) or anti-T lymphocyte globulin (ATLG) for the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). A comprehensive review of articles released up to October, 2018 was performed as a source of scientific evidence. Fourteen clinically relevant key questions to the domains indication, administration, and post-transplant management were developed and recommendations were produced using the Delphi technique involving a Panel of 14 experts. ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD. ATG/ATLG was also recommended prior to HLA-identical sibling peripheral HSCT with good but lesser bulk of evidence. In reduced intensity or nonmyeloablative conditioning regimens, ATG/ATLG was deemed appropriate to reduce the incidence of acute and chronic GvHD, but a higher risk of relapse should be taken into account. Recommendations regarding dose, application, and premedication were also provided as well as post-transplant infectious prophylaxis and vaccination. Overall, these recommendations can be used for a proper and safe application of polyclonal ATG/ATLG to prevent GvHD after allogeneic HSCT.

Authors+Show Affiliations

Institute of Hematology "Seragnoli", University Hospital "S. Orsola Malpighi", Bologna, Italy. francesca.bonifazi@unibo.it.Department of Hematology, Hôpital Brabois, CHRU Nancy and CNRS UMR 7365, Biopole del'Université del Lorraine, Vendoeuvre les Nancy, France."Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy. Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy.Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA.Freiburg University Medical Faculty and Medical Center, Department for Medicine, Hematology, Oncology and Stem Cell Transplantation, Freiburg, Germany.Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036, Graz, Austria.Service d'Hématologie clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, INSERM UMRs 938, Paris, France.Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland.Department of Oncology, University of Milano and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.Service d' Hématologie-greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Inserm UMR 976, Paris, France.Hematology Service, Hospital Clínico Universitario-INCLIVA; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.Department of Medicine, McMaster University, Hamilton, ON, Canada.IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.University Hospital Eppendorf, Hamburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31969678

Citation

Bonifazi, Francesca, et al. "Rabbit ATG/ATLG in Preventing Graft-versus-host Disease After Allogeneic Stem Cell Transplantation: Consensus-based Recommendations By an International Expert Panel." Bone Marrow Transplantation, 2020.
Bonifazi F, Rubio MT, Bacigalupo A, et al. Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel. Bone Marrow Transplant. 2020.
Bonifazi, F., Rubio, M. T., Bacigalupo, A., Boelens, J. J., Finke, J., Greinix, H., ... Kröger, N. (2020). Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel. Bone Marrow Transplantation, doi:10.1038/s41409-020-0792-x.
Bonifazi F, et al. Rabbit ATG/ATLG in Preventing Graft-versus-host Disease After Allogeneic Stem Cell Transplantation: Consensus-based Recommendations By an International Expert Panel. Bone Marrow Transplant. 2020 Jan 22; PubMed PMID: 31969678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel. AU - Bonifazi,Francesca, AU - Rubio,Marie-Thérèse, AU - Bacigalupo,Andrea, AU - Boelens,Jaap Jan, AU - Finke,Jürgen, AU - Greinix,Hildegard, AU - Mohty,Mohamad, AU - Nagler,Arnon, AU - Passweg,Jakob, AU - Rambaldi,Alessandro, AU - Socie,Gérard, AU - Solano,Carlos, AU - Walker,Irwin, AU - Barosi,Giovanni, AU - Kröger,Nicolaus, Y1 - 2020/01/22/ PY - 2019/09/03/received PY - 2020/01/13/accepted PY - 2019/12/04/revised PY - 2020/1/24/entrez JF - Bone marrow transplantation JO - Bone Marrow Transplant. N2 - This collaborative initiative aimed to provide recommendations on the use of polyclonal antithymocyte globulin (ATG) or anti-T lymphocyte globulin (ATLG) for the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). A comprehensive review of articles released up to October, 2018 was performed as a source of scientific evidence. Fourteen clinically relevant key questions to the domains indication, administration, and post-transplant management were developed and recommendations were produced using the Delphi technique involving a Panel of 14 experts. ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD. ATG/ATLG was also recommended prior to HLA-identical sibling peripheral HSCT with good but lesser bulk of evidence. In reduced intensity or nonmyeloablative conditioning regimens, ATG/ATLG was deemed appropriate to reduce the incidence of acute and chronic GvHD, but a higher risk of relapse should be taken into account. Recommendations regarding dose, application, and premedication were also provided as well as post-transplant infectious prophylaxis and vaccination. Overall, these recommendations can be used for a proper and safe application of polyclonal ATG/ATLG to prevent GvHD after allogeneic HSCT. SN - 1476-5365 UR - https://www.unboundmedicine.com/medline/citation/31969678/Rabbit_ATG/ATLG_in_preventing_graft-versus-host_disease_after_allogeneic_stem_cell_transplantation:_consensus-based_recommendations_by_an_international_expert_panel L2 - http://dx.doi.org/10.1038/s41409-020-0792-x DB - PRIME DP - Unbound Medicine ER -