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However, overexposure to ATG may increase cytomegalovirus (CMV), Epstein\u2010Barr virus (EBV) reactivation, non\u2010relapse mortality, and disease recurrence. To investigate the optimal dosing of ATG, we established a targeted dosing strategy based on ATG concentration monitoring for haploidentical peripheral blood stem cell transplantation (haplo\u2010PBSCT). The aim of this phase 2 trial is to evaluate the safety and efficacy of the ATG\u2010targeted dosing strategy in adult unmanipulated haplo\u2010PBSCT. ATG was administered for 4\u2009days (\u22125\u2009days to \u22122\u2009days) during conditioning. The ATG doses on \u22123\u2009days and \u22122\u2009days were adjusted by our dosing strategy to achieve the optimal ATG exposure. The primary endpoint was CMV reactivation on +180\u2009days. Between December 2020 and January 2022, 66 haplo\u2010PBSCT patients were enrolled and 63 of them were evaluable with a median follow\u2010up of 632\u2009days. The cumulative incidence of CMV reactivation was 36.7% and that of EBV was 58.7%. The 1\u2010year disease\u2010free survival was 82.5%, overall survival was 92.1%, and CD4+ T\u2010cell reconstruction on +100\u2009days was 76.8%. The most common severe regimen\u2010associated toxicities (&gt; grade 3) were infections (51.5%) and gastrointestinal toxicity (25.5%). A total of 102 haplo\u2010PBSCT patients who received the conventional fixed ATG dose (cumulative 10\u2009mg\/kg) comprised historical control. The outcomes in historical control were inferior to those of phase 2 trial cohort (CMV reactivation: 70.8%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001; EBV reactivation: 76.0%, <jats:italic>p<\/jats:italic>\u2009=\u2009.024; CD4\u2009+\u2009T\u2010cell reconstruction: 54.1%, <jats:italic>p<\/jats:italic>\u2009=\u2009.040). In conclusion, ATG\u2010targeted dosing strategy reduced CMV\/EBV reactivation and improved survival without increasing GVHD after haplo\u2010PBSCT. These advantages may be associated with accelerated immune reconstitution.<\/jats:p>","DOI":"10.1002\/ajh.27068","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T17:17:29Z","timestamp":1694711849000},"page":"1732-1741","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Targeted dosing of anti\u2010thymocyte globulin in adult unmanipulated haploidentical peripheral blood stem cell transplantation: A single\u2010arm, phase 2 trial"],"prefix":"10.1002","volume":"98","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7102-7521","authenticated-orcid":false,"given":"Haitao","family":"Wang","sequence":"first","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Wang","sequence":"additional","affiliation":[{"name":"Medical School of Chinese PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Wang","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jishan","family":"Du","sequence":"additional","affiliation":[{"name":"Medical School of Chinese PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Li","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangliu","family":"Shao","sequence":"additional","affiliation":[{"name":"Medical School of Chinese PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Peng","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songhua","family":"Luan","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Wang","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiangshu","family":"Jin","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunji","family":"Gao","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6872-2665","authenticated-orcid":false,"given":"Liping","family":"Dou","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"},{"name":"Medical School of Chinese PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3334-9113","authenticated-orcid":false,"given":"Daihong","family":"Liu","sequence":"additional","affiliation":[{"name":"Senior Department of Hematology The Fifth Medical Center of Chinese PLA General Hospital  Beijing China"},{"name":"Medical School of Chinese PLA  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199810223391702"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2008.03.005"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2005-05-2146"},{"key":"e_1_2_11_5_1","article-title":"Polyclonal anti\u2010thymocyte globulins for the prophylaxis of graft\u2010versus\u2010host disease after allogeneic stem cell or bone marrow transplantation in adults","volume":"9","author":"Theurich S","year":"2012","journal-title":"Cochrane Database Syst 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