Prevention of Chronic Graft-versus-host Disease and the Unique Role of Anti-human T-lymphocyte Immune Globulin

Abstract

C hronic graft-versus-host disease (GVHD) is a major cause of late morbidity and mortality post-allogeneic haematopoietic stemcell transplantation. Compared with acute GVHD, for which progress in preventative measures have been made, chronic GVHD describes a more diverse syndrome, and may adversely affect almost all organs in the body. A new prospective, multicentre, open-label, randomised phase III study (n=168) showed that the use of anti-human T-lymphocyte immune globulin (ATLG) in a myeloablative conditioning regimen for patients with acute leukaemia led to a significantly lower rate of chronic GVHD post-allogeneic transplantation compared with those receiving the same regimen without ATLG. Importantly, no increased rate of relapses in the patients who received ATLG was seen compared with those who did not. Thus, there was no apparent impairment in the graft-versus-leukaemia effect in ATLG-treated patients. The study was terminated at 2 years and more evidence about the long-term effect of ATLG on survival and GVHD relapses beyond this time-point are needed. Nonetheless, the findings represent a significant advance in the prevention of chronic GVHD.