Anti-thymocyte globulin dosing—per kg or per lymphocyte?

Rabbit anti-thymocyte globulin has been used in patients undergoing haemopoietic cell transplantation (HCT) since the 1970s, 1 Storb R Gluckman E Thomas ED et al. Treatment of established human graft-versus-host disease by antithymocyte globulin. Blood. 1974; 44: 56-75 PubMed Google Scholar and especially since 1998, when thymoglobulin (Sanofi, France) was licensed by the US Food and Drug Administration. Thymoglobulin and a similar product, grafalon (Neovii, Germany), are the only drugs documented in randomised trials to prevent chronic graft-versus-host disease (GvHD) and to improve survival that is free from chronic GvHD and relapse. 2 Bacigalupo A Lamparelli T Barisione G et al. Thymoglobulin prevents chronic graft-versus-host disease, chronic lung dysfunction, and late transplant-related mortality: long-term follow-up of a randomized trial in patients undergoing unrelated donor transplantation. Biol Blood Marrow Transplant. 2006; 12: 560-565 Summary Full Text Full Text PDF PubMed Scopus (282) Google Scholar , 3 Walker I Panzarella T Couban S et al. Pretreatment with anti-thymocyte globulin versus no anti-thymocyte globulin in patients with haematological malignancies undergoing haemopoietic cell transplantation from unrelated donors: a randomised, controlled, open-label, phase 3, multicentre trial. Lancet Oncol. 2016; 17: 164-173 Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar , 4 Socie G Schmoor C Bethge WA et al. Chronic graft-versus-host disease: long-term results from a randomized trial on graft-versus-host disease prophylaxis with or without anti-T-cell globulin ATG-Fresenius. Blood. 2011; 117: 6375-6382 Crossref PubMed Scopus (239) Google Scholar , 5 Kroger N Solano C Wolschke C et al. Antilymphocyte globulin for prevention of chronic graft-versus-host disease. N Engl J Med. 2016; 374: 43-53 Crossref PubMed Scopus (257) Google Scholar However, the dose of thymoglobulin to prevent GvHD safely, without abrogating the anti-leukaemic and anti-viral effects of donor lymphocytes, remains unknown in 2017. Association between anti-thymocyte globulin exposure and survival outcomes in adult unrelated haemopoietic cell transplantation: a retrospective, pharmacodynamic cohort analysisExposure to ATG affects survival after HCT in adults, stressing the importance of optimum ATG dosing. Individualised dosing of ATG, based on lymphocyte counts rather than bodyweight, might improve survival chances after HCT. Full-Text PDF Correction to Lancet Haematol 2017; 4: e154–55Storek J. Anti-thymocyte globulin dosing—per kg or per lymphocyte? Lancet Haematol 2017: 4: e154–55—In the reference list, the correct citation for reference 8 should be: Admiraal R, Nierkens S, de Witte MA, et al. Association between anti-thymocyte globulin exposure and survival outcomes in adult unrelated haemopoietic cell transplantation: a retrospective pharmacodynamic cohort analysis. This correction has been made to the online version as of April 28, 2017. Full-Text PDF