Antithymocyte globulin , for

Giebel S, Wojnar J, Krawczyk-Kulis M, Markiewicz M, et al. 2006. Treosulfan, cyclophosphamide and antithymocyte globulin for allogeneic hematopoietic cell transplantation in acquired severe aplastic anemia. Ann Transplant. 11 23-27. 

Bacigalupo A, Lamparelli T, Bruzzi P, et al. Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants from unrelated donors 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO). Blood 2001 98 2942-2947. 

Nonspecific immunosuppressive therapy in an adult patient is usually through cyclosporin (35), started intravenously at the time of transplantation, and given orally once feeding is tolerated. Typically, methylprednisone is started also at the time of transplantation, then reduced to a maintenance dose. A athioprine (31) may also be used in conjunction with the prednisone to achieve adequate immunosuppression. Whereas the objective of immunosuppression is to protect the transplant, general or excessive immunosuppression may lead to undesirable compHcations, eg, opportunistic infections and potential malignancies. These adverse effects could be avoided if selective immunosuppression could be achieved. Suspected rejection episodes are treated with intravenous corticosteroids. Steroid-resistant rejection may be treated with monoclonal antibodies (78,79) such as Muromonab-CD3, specific for the T3-receptor on human T-ceUs. Alternatively, antithymocyte globulin (ATG) may be used against both B- and T-ceUs. 

Also known as antibody-mediated rejection, humoral rejection is the process of creating graft-specific antibodies.1,4 This type of rejection occurs less frequently than cell-mediated acute rejection. Humoral rej ection is characterized by deposition of immunoglobulins and complement in allograft tissues. Treatment for this type of rejection is not well defined, yet several reports have shown that treatments such as plasmapheresis, immunoglobulin therapy, rituximab, and/or antithymocyte globulin maybe effective. 

The final chapter comprises two reports on clinical haematopoietic stem cell transplantation (HSCT). Viktor Khomenko shares the experience of the Kiev center for stem cell transplantation. The final article in this book by Axel Zander and colleagues summarises data with the use of Antithymocyte globuline (ATG) in (HLA-mismatched) allogeneic transplantation, an approach which was promoted in the Hamburg Clinic for HSCT. 

Therapy, when replacement of the marrow by allogeneic haematopoietic stem cell transplantation is not possible, comprises 500 mg of methylpred-nisolone by 8 hour intravenous infusion repeated for five consecutive days. Concurrently 15 mg/kg of antilymphocyte or antithymocyte globulin is given... 

Antisera directed against lymphocytes have been prepared sporadically for over 100 years. With the advent of human organ transplantation as a therapeutic option, heterologous antilymphocyte globulin (ALG) took on new importance. ALG and antithymocyte globulin (ATG) are now in clinical use in many medical centers, especially in transplantation programs. The antiserum is usually obtained by immunization of large animals such as horses or sheep with human lymphoid cells. 

Parenteral 100 mg/mL prefilled glass syringes for SC injection Antithymocyte globulin (Thymoglobulin)... 

Antithymocyte globulin (rabbit) is approved for the reversal of acute rejection. A double-blind, randomized trial of thymoglobulin vs ATGAM was conducted in 163 renal recipients with rejection. Thymoglobulin had a higher reversal rate than ATGAM (88% vs 76%, p=0.027). Transplantation 66 29-37, July 15, 1998. 

Immunosuppression is used in patients who are not candidates for bone marrow transplantation due to age or to the lack of a donor (up to 70%). Horse antithymocyte globulin (ATG) or rabbit antilymphocyte globulin (ALG) induce haematological responses (transfusion-independence and freedom from infection) in 40-50%. The addition of ciclosporin to ATG or ALG improves response rates to 70-80% and survival rates in responders to 90%. Adverse effects of ATG and ALG include anaphylaxis, exacerbation of cytopenias and serum sickness. Ciclosporin is nephrotoxic. In refractory patients G-CSF and erythropoetin can improve blood counts, as can androgens in some patients. 

Some clinicians will use CMV prophylaxis for all patients receiving transplants. Others will reserve prophylaxis for only those patients who are at a higher risk for CMV infection, such as those with donor-recipient CMV serology mismatch or recipients who have received induction therapy or rejection treatment with antithymocyte globulin. A third strategy is to preemptively treat patients who have laboratory evidence of CMV infection. 

ANC absolute neutrophil count ARDS acute respiratory distress syndrome ASCO American Society for Clinical Oncology ATG antithymocyte globulin BAL bronchoalveolar lavage... 

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