{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T06:18:44Z","timestamp":1768717124693,"version":"3.49.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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% <jats:italic>vs<\/jats:italic>. 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1526513","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T06:45:03Z","timestamp":1737960303000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Low dose ATG-Fresenius for GVHD prophylaxis: a comparative study with ATG-Thymoglobulin"],"prefix":"10.3389","volume":"16","author":[{"given":"Itai","family":"Falicovich","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boaz","family":"Nachmias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shlomo","family":"Elias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eran","family":"Zimran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adir","family":"Shaulov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Polina","family":"Stepensky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Batia","family":"Avni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sigal","family":"Grisariu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.leu.2404683","article-title":"Mechanisms of action of antithymocyte globulin: T-cell depletion and beyond","volume":"21","author":"Mohty","year":"2007","journal-title":"Leukemia"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2013.143","article-title":"Effective prevention of GVHD using in vivo T-cell depletion with anti-lymphocyte globulin in HLA-identical or -mismatched sibling peripheral blood stem cell transplantation","volume":"49","author":"Wolschke","year":"2014","journal-title":"Bone Marrow Transpl"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V98.10.2942","article-title":"Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants\u00a0from unrelated donors: 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO)","volume":"98","author":"Bacigalupo","year":"2001","journal-title":"Blood"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(09)70225-6","article-title":"Standard graft-versus-host disease prophylaxis with or without anti-T-cell globulin in haematopoietic cell transplantation from matched unrelated donors: a randomised, open-label, multicentre phase 3 trial","volume":"10","author":"Finke","year":"2009","journal-title":"Lancet Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(15)00462-3","article-title":"Pretreatment with anti-thymocyte globulin versus no anti-thymocyte globulin in patients with haematological Malignancies undergoing haemopoietic cell transplantation from unrelated donors: a randomised, controlled, open-label, phase 3, multicentre trial","volume":"17","author":"Walker","year":"2016","journal-title":"Lancet Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-01-329821","article-title":"Chronic graft-versus-host disease: long-term results from a randomized trial on graft-versus-host disease prophylaxis with or without anti\u2013T-cell globulin ATG-Fresenius","volume":"117","author":"Soci\u00e9","year":"2011","journal-title":"Blood"},{"key":"B7","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1056\/NEJMoa1506002","article-title":"Antilymphocyte globulin for prevention of chronic graft-versus-host disease","volume":"374","author":"Kr\u00f6ger","year":"2016","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","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":"Bacigalupo","year":"2006","journal-title":"Biol Blood Marrow Transpl"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12514","article-title":"A comprehensive and quantitative analysis of the major specificities in rabbit antithymocyte globulin preparations","volume":"13","author":"Popow","year":"2013","journal-title":"Am J Transpl"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.00315","article-title":"Differential elimination of anti-thymocyte globulin of fresenius and genzyme impacts T-cell reconstitution after hematopoietic stem cell transplantation","volume":"10","author":"Oostenbrink","year":"2019","journal-title":"Front Immunol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"204062072110637","DOI":"10.1177\/20406207211063783","article-title":"Association between preconditioning absolute lymphocyte count and transplant outcomes in patients undergoing matched unrelated donor allogeneic hematopoietic stem cell transplantation with reduced-intensity conditioning and anti-thymocyte globulin","volume":"12","author":"Seo","year":"2021","journal-title":"Ther Adv Hematol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2016.148510","article-title":"Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation","volume":"102","author":"Baron","year":"2017","journal-title":"Haematologica"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00150","article-title":"Antithymocyte globulin for matched sibling donor transplantation in patients with hematologic Malignancies: A multicenter, open-label, randomized controlled study","volume":"38","author":"Chang","year":"2020","journal-title":"J Clin Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-020-0792-x","article-title":"Rabbit ATG\/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel","volume":"55","author":"Bonifazi","year":"2020","journal-title":"Bone Marrow Transpl"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30417-5","article-title":"Efficacy of two different doses of rabbit anti-T-lymphocyte globulin to prevent graft-versus-host disease in children with haematological Malignancies transplanted from an unrelated donor: a multicentre, randomised, open-label, phase 3 trial","volume":"18","author":"Locatelli","year":"2017","journal-title":"Lancet Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1038\/bmt.2011.225","article-title":"Intensification of GVHD prophylaxis with low-dose ATG-F before allogeneic PBSC transplantation from HLA-identical siblings in adult patients with hematological Malignancies: results from a retrospective analysis","volume":"47","author":"Bonifazi","year":"2012","journal-title":"Bone Marrow Transpl"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2018.07.011","article-title":"Low-dose anti-T lymphoglobulin as prophylaxis for graft-versus-host disease in unrelated donor transplantations for acute leukemias and myelodysplastic syndromes","volume":"24","author":"Bonifazi","year":"2018","journal-title":"Biol Blood Marrow Transplant J Am Soc Blood Marrow Transpl"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2015.1045901","article-title":"The efficacy and safety of rabbit anti-thymocyte globulin vs rabbit anti-T-lymphocyte globulin in peripheral blood stem cell transplantation from unrelated donors","volume":"57","author":"Huang","year":"2016","journal-title":"Leuk Lymphoma"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1080\/10428194.2018.1439584","article-title":"Comparative study on ATG-thymoglobulin versus ATG-fresenius for the graft-versus-host disease (GVHD) prophylaxis in allogeneic stem cell transplantation from matched unrelated donor: a single-centre experience over the contemporary years","volume":"59","author":"Polverelli","year":"2018","journal-title":"Leuk Lymphoma"},{"key":"B20","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.bbmt.2015.09.001","article-title":"International, multicenter standardization of acute graft-versus-host disease clinical data collection: A report from the Mount Sinai acute GVHD international consortium","volume":"22","author":"Harris","year":"2016","journal-title":"Biol Blood Marrow Transplant J Am Soc Blood Marrow Transpl"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-018-0204-7","article-title":"EBMT-NIH-CIBMTR Task Force position statement on standardized terminology & guidance for graft-versus-host disease assessment","volume":"53","author":"Schoemans","year":"2018","journal-title":"Bone Marrow Transpl"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-01-552984","article-title":"Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation","volume":"123","author":"Armand","year":"2014","journal-title":"Blood"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1704957","article-title":"Antithymocyte globulin for the prevention of graft-versus-host disease after unrelated hematopoietic stem cell transplantation for acute myeloid leukemia: results from the multicenter German cooperative study group","volume":"35","author":"Basara","year":"2005","journal-title":"Bone Marrow Transpl"},{"key":"B24","doi-asserted-by":"publisher","first-page":"980924","DOI":"10.1155\/2015\/980924","article-title":"Comparing two types of rabbit ATG prior to reduced intensity conditioning allogeneic hematopoietic SCT for hematologic Malignancies","volume":"2015","author":"Paiano","year":"2015","journal-title":"Bone Marrow Res"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-023-05220-7","article-title":"Outcomes of patients with hematological Malignancies who undergo unrelated donor hematopoietic stem cell transplantation with ATG-Fresenius versus ATG-Genzyme","volume":"102","author":"Wang","year":"2023","journal-title":"Ann Hematol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s12032-014-0465-y","article-title":"Outcomes of peripheral blood stem cell transplantation patients from HLA-mismatched unrelated donor with antithymocyte globulin (ATG)-Thymoglobulin versus ATG-Fresenius: a single-center study","volume":"32","author":"Huang","year":"2015","journal-title":"Med Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1038\/leu.2012.135","article-title":"Impact of graft-versus-host disease after reduced-intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European group for blood and marrow transplantation","volume":"26","author":"Baron","year":"2012","journal-title":"Leukemia"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s00277-020-04014-5","article-title":"Comparison of ATG-thymoglobulin with ATG-Fresenius for Epstein-Barr virus infections and graft-versus-host-disease in patients with hematological Malignances after haploidentical hematopoietic stem cell transplantation: a single-center experience","volume":"99","author":"Zhou","year":"2020","journal-title":"Ann Hematol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.45.0247","article-title":"Graft-versus-host disease and graft-versus-tumor effects after allogeneic hematopoietic cell transplantation","volume":"31","author":"Storb","year":"2013","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13719","article-title":"Dynamics of Epstein-Barr virus on post-transplant lymphoproliferative disorders after antithymocyte globulin-conditioned allogeneic hematopoietic cell transplant","volume":"23","author":"Lindsay","year":"2021","journal-title":"Transpl Infect Dis Off J Transplant Soc"},{"key":"B31","doi-asserted-by":"publisher","first-page":"4992","DOI":"10.1182\/blood-2008-09-178046","article-title":"Risk\u00a0factors for lymphoproliferative disorders after allogeneic hematopoietic cell transplantation","volume":"113","author":"Landgren","year":"2009","journal-title":"Blood"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V120.21.4486.4486","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":"Yu","year":"2012","journal-title":"Blood"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(17)30029-7","article-title":"Association between anti-thymocyte globulin exposure and survival outcomes in adult unrelated haemopoietic cell transplantation: a multicentre, retrospective, pharmacodynamic cohort analysis","volume":"4","author":"Admiraal","year":"2017","journal-title":"Lancet Haematol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1186\/s13045-020-00923-0","article-title":"Post-transplant cyclophosphamide versus antithymocyte globulin in patients with acute myeloid leukemia in first complete remission undergoing allogeneic stem cell transplantation from 10\/10 HLA-matched unrelated donors","volume":"13","author":"Brissot","year":"2020","journal-title":"J Hematol OncolJ Hematol Oncol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-019-0682-2","article-title":"Posttransplantation cyclophosphamide vs. antithymocyte globulin as GVHD prophylaxis for mismatched unrelated hematopoietic stem cell transplantation","volume":"55","author":"Nykolyszyn","year":"2020","journal-title":"Bone Marrow Transpl"},{"key":"B36","doi-asserted-by":"publisher","first-page":"101080","DOI":"10.1016\/j.blre.2023.101080","article-title":"Combining post-transplant cyclophosphamide with antithymocyte globulin for graft-versus-host disease prophylaxis in hematological\u00a0Malignancies","volume":"62","author":"Dul\u00e9ry","year":"2023","journal-title":"Blood Rev"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1526513\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T06:45:05Z","timestamp":1737960305000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1526513\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,27]]},"references-count":36,"alternative-id":["10.3389\/fimmu.2025.1526513"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1526513","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,27]]},"article-number":"1526513"}}