International Journal of Hematology

, Volume 110, Issue 1, pp 22–29 | Cite as

Effect of antithymocyte globulin on HLA-mismatched unrelated transplantation

  • Koji KawamuraEmail author
Progress in Hematology Recent progress in allogeneic stem cell transplantation using alternative stem cell sources


HLA 1-locus-mismatched unrelated donors (1MMUD) are often considered as alternative donors in allogeneic hematopoietic stem-cell transplantation (allo-HCT) when an HLA-matched related or unrelated donor is unavailable. However, HLA mismatch remains a major risk factor for acute and chronic graft-versus-host disease (GVHD). Antithymocyte globulin (ATG) has been used to prevent acute and chronic GVHD, and multiple studies have shown that use of ATG is associated with decreased acute and chronic GVHD, which is associated with improved QOL. However, at high doses, ATG may lead to an increase in fatal infection, relapse, or delayed engraftment. The optimal ATG dose for MMUD remains unclear. The optimal ATG dose should be determined based on a fine balance between the reduction of GVHD and the risk of relapse, fatal infection, and/or delayed engraftment. Interestingly, promising results from some recent Asian studies suggest that a low dose of ATG may improve non-relapse mortality and overall survival without increasing relapse or fatal infection in allo-HCT from an HLA-mismatched unrelated donor. A randomized control trial is expected to confirm these results in Japan. In addition, pharmacokinetic/pharmacodynamic studies may help to identify the personalized optimal ATG dose.


Allogeneic hematopoietic transplantation HLA-mismatched unrelated donor Antithymocyte globulin Graft-versus-host disease Optimal ATG dose 



This work was supported in part by the Japan Leukemia Research Fund. The author is grateful to Drs. Yoshinobu Kanda (Jichi Medical University) and Junya Kanda (Kyoto University) for their suggestions and advice.

Compliance with ethical standards

Conflict of interest

The author declares no conflict of interest.


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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  1. 1.Division of Hematology, Saitama Medical CenterJichi Medical UniversitySaitama-cityJapan

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