Graft-versus-host disease drug scrutinized

Graft-versus-host-disease (GVHD) is a major complication of bone marrow transplantation in which immune cells residing in the transplanted tissue turn against their new host. Antithymocyte globulin (ATG), a drug that depletes T lymphocytes, is given to transplant patients to try and prevent that happening. Yet, there are few convincing data available on how good ATG is at preventing the disease.

A team of researchers from the United States, France and Lebanon conducted a systematic review of seven randomized control trials involving a total of 733 patients to determine the effectiveness of ATG. They publish their findings in the journal Leukemia.

They found that ATG was effective in reducing the incidence of the most severe forms of acute GVHD. It did not, however, reduce the incidence of the less severe forms of GVHD, improve overall survival or decrease non-relapse mortality. None of the trials included in the review assessed the impact of ATG on chronic GVHD, which can strike 100 days after surgery.

The sample sizes in each of the trials included in the review remains too small to detect significant risk reductions, caution the researchers. They suggest that larger randomized controlled trials are needed to conduct a conclusive investigation of the use of ATG to prevent GVHD, especially as the immunosuppression caused by the treatment renders the patient more susceptible to serious infection.

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