{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T03:02:02Z","timestamp":1787022122673,"version":"build-2736575974"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T00:00:00Z","timestamp":1681776000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003810","name":"Hospital de Cl\u00ednicas de Porto Alegre","doi-asserted-by":"publisher","award":["2019-0138"],"award-info":[{"award-number":["2019-0138"]}],"id":[{"id":"10.13039\/501100003810","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>\n                    Rabbit anti-thymocyte globulin (ATG) has been used in allogeneic hematopoietic stem cell transplantation (Allo-HSCT) for graft-versus-host disease (GvHD) prophylaxis. Since the best dose has not been defined yet, this study aimed to determine the efficacy and safety of different doses of ATG in Allo-HSCT. Data sources were MEDLINE\/PUBMED, EMBASE, Cochrane Library, Web of Science, LILACS, and SciELO. Studies were eligible when comparing doses of ATG. The higher dose was in the intervention group. A total of 22 articles (2002\u20132022) were included. Higher doses (4\u201312 mg\/kg) of ATG-T reduced the incidence of grade III-IV acute GvHD (RR 0.60; 95%CI 0.42\u20130.84) and limited chronic GvHD (RR 0.64 95%CI 0.45\u20130.92) compared with lower doses (2\u20137.5 mg\/kg). Higher doses increased the Epstein-Barr virus (RR 1.90 95% CI 1.49\u20132.42) and\n                    <jats:italic>Cytomegalovirus<\/jats:italic>\n                    reactivation (RR, 1.30; 95% CI 1.03\u20131.64). Relapse rates were higher in the higher dose group (RR 1.34, 95% CI 1.07\u2013167). The ATG-T dose \u22657mg\/kg versus the lower dose showed a number needed to treat 7.4 for acute GvHD III-IV, with a number to harm of 7.7 for relapse at one year in the higher dose group. A dose lower than 7 mg\/kg suggests a better risk-benefit ratio than a higher one. Well-designed RCT is needed to define the best risk-benefit doses.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial registration:<\/jats:bold>\n                    Trial registration number: PROSPERO:\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42020173449\" xlink:type=\"simple\">https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42020173449<\/jats:ext-link>\n                    .\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0284476","type":"journal-article","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T13:25:32Z","timestamp":1681824332000},"page":"e0284476","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Systematic review and meta-analysis of anti-thymocyte globulin dosage as a component of graft-versus-host disease prophylaxis"],"prefix":"10.1371","volume":"18","author":[{"given":"Joice","family":"Zuckermann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7013-2127","authenticated-orcid":true,"given":"Bruno Mateus de","family":"Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thiago Almirante","family":"Cunha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Paz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4730-7988","authenticated-orcid":true,"given":"Leila Beltrami","family":"Moreira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,4,18]]},"reference":[{"issue":"8","key":"pone.0284476.ref001","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1080\/10428194.2016.1266624","article-title":"Efficacy of antithymocyte globulin for allogeneic hematopoietic cell transplantation: a systematic review and meta-analysis","volume":"58","author":"Y Arai","year":"2017","journal-title":"Leuk Lymphoma"},{"key":"pone.0284476.ref002","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","author":"JAC Sterne","year":"2019","journal-title":"BMJ"},{"key":"pone.0284476.ref003","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomized studies of interventions","author":"JAC Sterne","year":"2016","journal-title":"BMJ"},{"issue":"10","key":"pone.0284476.ref004","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.1182\/blood.V98.10.2942","article-title":"Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants from unrelated donors: 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO).","volume":"98","author":"A Bacigalupo","year":"2001","journal-title":"Blood"},{"issue":"5","key":"pone.0284476.ref005","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/j.bbmt.2005.12.034","article-title":"Thymoglobulin prevents chronic graft-versus-host disease, chronic lung dysfunction, and late transplant-related mortality: long-term follow-up of a randomized trial in patients undergoing unrelated donor transplantation.","volume":"12","author":"A Bacigalupo","year":"2006","journal-title":"Biol Blood Marrow Transplant."},{"issue":"3","key":"pone.0284476.ref006","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1038\/bmt.2013.191","article-title":"Influence of two different doses of antithymocyte globulin in patients with standard-risk disease following haploidentical transplantation: a randomized trial","volume":"49","author":"Y Wang","year":"2014","journal-title":"Bone Marrow Transplant"},{"issue":"15","key":"pone.0284476.ref007","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1002\/cncr.30540","article-title":"Optimal dose of rabbit thymoglobulin in conditioning regimens for unmanipulated, haploidentical, hematopoietic stem cell transplantation: long-term outcomes of a prospective randomized trial","volume":"123","author":"YJ Chang","year":"2017","journal-title":"Cancer"},{"issue":"21","key":"pone.0284476.ref008","article-title":"Effect of Antithymocyte Globulin Dosage for Prophylactic Gvhd On Epstein-Barr Virus Reactivation and Diseases in Allogeneic Hematopoietic Stem Cell Transplantation","volume":"120","author":"GP Yu","year":"2012","journal-title":"Blood"},{"issue":"22","key":"pone.0284476.ref009","doi-asserted-by":"crossref","DOI":"10.1182\/blood.V128.22.3393.3393","article-title":"The impact of antithymocyte globulin (ATG) dose in allogeneic hematopoietic stem cell transplantation with HLA mismatched donors.","volume":"128","author":"Y Choi","year":"2016","journal-title":"Blood"},{"key":"pone.0284476.ref010","first-page":"S200","article-title":"Anti-thymocyte globulin (ATG) dose of 4.5 mg\/kg vs 7.5 mg\/kg did not result in a significant difference in the incidence of moderate to severe chronic graft vs host disease in allogeneic hematopoietic stem cell transplantation (HSCT) from unrelated donor.","volume":"52","author":"S Park","year":"2017","journal-title":"Bone Marrow 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