{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:05:57Z","timestamp":1784696757314,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003463","name":"Haematology Society of Australia and New Zealand","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003463","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000926","name":"Leukaemia Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000926","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012775","name":"Royal Melbourne Hospital","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012775","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>\n                    Although anti-thymocyte globulin (ATG) is commonly used as prophylaxis against graft-versus-host disease (GVHD) following allogeneic haematopoietic stem cell transplantation (alloSCT), there is considerable inter-patient variability in ATG exposure. The impact of ATG exposure in outcomes following reduced intensity conditioning (RIC)-alloSCT remains unknown. We explored the impact of post-transplant ATG exposure (PT-ATG-exp) in 68 adults with haematological malignancies undertaking first RIC-alloSCT with ATG (Thymoglobulin, total dose 4.5mg\/kg, day -3 to -1 alloSCT). Post-transplant ATG exposure was determined by area under the curve (AUC) through analysis of sera collected at standardised timepoints. Post-transplant ATG exposure range was highly variable [46\u2013420 arbitrary units (AU) per day\/mL]. Day 0 ATG concentration and day 0\u201314 ATG AUC highly correlated with PT-ATG-exp (R\u00a0=\u00a00.93 and 0.99, respectively,\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0&amp;lt;\u00a00.001). Using a Cox proportional hazards model, patients with PT-ATG-exp between 80\u2013135 AU per day\/mL had inferior 2-year GRFS compared to the remainder of the cohort [25% (95% CI, 11%-56%) vs 54% (95% CI, 40%-73%),\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.02; HR 2.01 (95% CI, 1.04-3.86,\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.04] due to higher incidence of grade III-IV acute GVHD [33% (95% CI, 16%-51%) vs 12% (95% CI, 4%-24%),\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.034; HR 2.95 (95% CI, 0.99-8.83,\n                    <jats:italic>P<\/jats:italic>\n                    \u00a0=\u00a00.05)]. Recipients with the highest PT-ATG-exp (quartile 4: 185\u2013420 AU per ml\/day) had the lowest incidence of grade III-IV acute GVHD (0% at 180-days) but also lowest median CD3\n                    <jats:sup>+<\/jats:sup>\n                    chimerism (85%) and highest incidence of mixed donor chimerism (CD3\n                    <jats:sup>+<\/jats:sup>\n                    : 93% and CD3\n                    <jats:sup>-<\/jats:sup>\n                    : 33%) at day 100. In this analysis, PT-ATG-exp influenced post-transplant outcomes including GVHD incidence and donor chimerism following in RIC-alloSCT.\n                  <\/jats:p>","DOI":"10.3389\/fimmu.2026.1879058","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T04:38:33Z","timestamp":1784695113000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Post-transplant anti-thymocyte globulin exposure predicts graft-versus-host disease and donor chimerism outcomes in reduced intensity conditioning allogeneic stem cell transplantation"],"prefix":"10.3389","volume":"17","author":[{"given":"Ray Mun","family":"Koo","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne","place":["Melbourne, VIC, Australia"]},{"name":"Australian Cancer Research Foundation (ACRF) Translational Research Laboratory, The Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]},{"name":"Clinical Haematology, Peter MacCallum Cancer Centre - Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Davis","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne","place":["Melbourne, VIC, Australia"]},{"name":"Australian Cancer Research Foundation (ACRF) Translational Research Laboratory, The Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandy","family":"Ludford-Menting","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne","place":["Melbourne, VIC, Australia"]},{"name":"Australian Cancer Research Foundation (ACRF) Translational Research Laboratory, The Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Wong","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne","place":["Melbourne, VIC, Australia"]},{"name":"Australian Cancer Research Foundation (ACRF) Translational Research Laboratory, The Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]},{"name":"Department of Clinical Haematology, Austin Health","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Koldej","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne","place":["Melbourne, VIC, Australia"]},{"name":"Australian Cancer Research Foundation (ACRF) Translational Research Laboratory, The Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne","place":["Melbourne, VIC, Australia"]},{"name":"Australian Cancer Research Foundation (ACRF) Translational Research Laboratory, The Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]},{"name":"Clinical Haematology, Peter MacCallum Cancer Centre - Royal Melbourne Hospital","place":["Melbourne, VIC, Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.01217","article-title":"The graft-versus-leukemia effect in AML","volume":"9","author":"Sweeney","year":"2019","journal-title":"Front Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.beha.2023.101476","article-title":"Graft 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