Differential Elimination of Anti-Thymocyte Globulin of Fresenius and Genzyme Impacts T-Cell Reconstitution After Hematopoietic Stem Cell Transplantation

Anti-thymocyte globulin (ATG) is a lymphocyte depleting agent applied in hematopoietic stem cell transplantation (HSCT) to prevent rejection and Graft-vs.-Host Disease (GvHD). In this study, we compared two rabbit ATG products, ATG-Genzyme (ATG-GENZ), and ATG-Fresenius (ATG-FRES), with respect to dosing, clearance of the active lymphocyte binding component, post-HSCT immune reconstitution and clinical outcome. Fifty-eigth pediatric acute leukemia patients (n = 42 ATG-GENZ, n = 16 ATG-FRES), who received a non-depleted bone marrow or peripheral blood stem cell graft from an unrelated donor were included. ATG-GENZ was given at a dosage of 6–10 mg/kg; ATG-FRES at 45–60 mg/kg. The active component of ATG from both products was cleared at different rates. Within the ATG-FRES dose range no differences were found in clearance of active ATG or T-cell re-appearance. However, the high dosage of ATG-GENZ (10 mg/kg), in contrast to the low dosage (6–8 mg/kg), correlated with prolonged persistence of active ATG and delayed T-cell reconstitution. Occurrence of serious acute GvHD (grade III–IV) was highest in the ATG-GENZ-low dosage group. These results imply that dosing of ATG-GENZ is more critical than dosing of ATG-FRES due to the difference in clearance of active ATG. This should be taken into account when designing clinical protocols

Decreased Response After Conjugated Meningococcal Serogroup C Vaccination in Children With Down Syndrome

Transplantation and immunomodulatio

Occurrence of human antibodies to thymoglobulin is frequent and associated with transplant-related toxicity after haematopoietic stem cell transplantation

Transplantation and immunomodulatio

NK-cell recovery after allogeneic HSCT occurs in the presence of circulating Thymoglobulin (ATG) or Alemtuzumab

Transplantation and immunomodulatio

Omitting methotrexate prophylaxis increases acute graft-versus-host disease in identical sibling transplantation in childhood leukaemia

Transplantation and immunomodulatio

Biopsies Are Essential During Monitoring of Response to Mesenchymal Stromal Cell Therapy in Children with Gastrointestinal Acute Graft Versus Host Disease

Transplantation and immunomodulatio

Impaired avidity maturation after tetanus toxoid booster in children with Down Syndrome

Down syndrome children show a decreased avidity of the antibody response after tetanus toxoid booster vaccination at 9 years of age suggesting impaired memory B cell selection in the germinal center. Clinicians need to be aware of this ongoing subtle immunologic deficit in Down syndrome.Transplantation and immunomodulatio