A new study published in American Journal of Hematology compared two treatment options for Graft versus host disease (GVHD).
Graft Versus Host Disease
GVHD is a rare complication that can occur after a stem cell or bone marrow transplant. It is caused by the newly transplanted donor cells attacking the transplant recipient’s body. Symptoms may include skin rash, mouth sores, dry eyes, liver inflammation, development of scar tissue in the skin and joints, and damage to the lungs. The exact cause is unknown but likely results from a complex immune-mediated interaction between the donor and recipient cells.
ATLG and ATG
Anti-T-lymphocyte globulin (ATLG) and anti-thymocyte globulin (ATG) can prevent acute and chronic GVHD following allogeneic hematopoietic stem cell transplantation (allo-HSCT). The study by Notarantonio and colleagues was designed to compare clinical outcomes and broad immune reconstitution parameters between the two pre-transplant treatments. This study enrolled 114 adult patients who received a transplant after receiving either ATG (50) or ATLG (64).
Study Results
The median age for the study population was 58 years and pretransplant characteristics were comparable between the two groups. The use of ATLG was associated with a two-fold reduction in Grade II-IV acute GVHD incidence, compared with ATG. Outcomes of ATLG also included improved severe GVHD and relapse-free survival. Similar relapse incidence was observed in both ATLG and ATG. ATLG also reduced IL-15, however the treatment also increased IL-21 serum concentrations and caused a significant reduction in PD1+ T cells.
Additionally, immunosequencing of vβ T cell receptor repertoires illustrated similar quantitative characteristics, such as clonality and diversity, across both groups. However, different qualitative features were observed in the ATLG group compared to the ATG group. For example, the ATLG group presented with reduced hyper-expanded T cell clones and higher variability in distribution of complementarity-determining region 3 lengths.
Based on these results, ATLG appears to more effectively regulate alloreactive T cell activation and better prevent GVHD while preserving graft-versus-leukemia response. Following these findings, a phase 3 clinical trial comparing ATLG and ATG has been initiated.
For more information on GVHD and other rare autoimmune conditions, visit https://checkrare.com/diseases/autoimmune-and-auto-inflammatory-disorders/
References:
Notarantonio AB, et al. Differential Clinical and Immunological Impacts of Anti–T-Lymphocyte Globulin (ATLG) vs. Anti-Thymocyte Globulin (ATG) in Preventing Graft-Versus-Host Disease Post-Allogeneic Hematopoietic Stem Cell Transplantation: A Comparative Study. Am J Hematol 2025 Apr;100: 626-627. https://doi.org/10.1002/ajh.27619