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A Comparative Study of Various Formulations of Rabbit Anti−thymocyte Globulin for Graft vs. Host Disease Prophylaxis


Jaroslaw Domaga?a

Allogeneic hematopoietic stem cell transplantation is a potential curative therapy often employed for patients with haematological malignancies. Over the past two decades, numerous randomized controlled trials, reviews, and meta-analyses have investigated the effectiveness of rabbit anti-thymocyte globulin in preventing graft vs. host disease. However, only a limited number of these studies have aimed to compare different formulations of r-ATG. Given that the most recent article comparing various r-ATGs for GvHD prevention dates back to 2017, we conducted a systematic review of literature published from 2017 to the present using Indexed at, Scopus, Cochrane, and MEDLINE. Our primary focus was on acute GvHD (aGvHD) and chronic GvHD (cGvHD) prevention. We meticulously analyzed five studies in total; among these, four studies examined differences between Thymoglobulin (ATG-T) and Grafalon (ATG-G), while one investigated the impact of ATG-T dosage. Overall, the utilization of different r-ATG types does not appear to significantly influence cGvHD, aGvHD grades II–IV, transplant-related mortality (TRM), overall survival (OS), non-relapse mortality (NRM), leukemia-free survival (LFS), relapse rates, overall infection rates, and reactivation of the Epstein-Barr virus (EBV). However, conflicting data exists for aGvHD grades III–IV, graft vs. host-free survival (GRFS), moderate to severe cGvHD, and reactivation of the cytomegalovirus (CMV). Through our comprehensive research, our aim was to succinctly present the latest findings on r-ATGs in allo-HCT and provide insights into the distinctions among various ATG formulations in terms of their targets and origins.

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