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. 2025 Jun;29(11):e70450.
doi: 10.1111/jcmm.70450.

Efficacy and Safety of Combining r-ATG With PTCy for GvHD Prophylaxis in Haploidentical HSC Transplantation for Malignancies-A Systematic Review

Joseph M John  1 , Uday Kulkarni  2 , Dinesh Pendharkar  3 , Sachin Jadhav  4
Affiliations

Efficacy and Safety of Combining r-ATG With PTCy for GvHD Prophylaxis in Haploidentical HSC Transplantation for Malignancies-A Systematic Review

Joseph M John et al. J Cell Mol Med. 2025 Jun.

Abstract

Allogeneic haematopoietic stem cell transplantation (HSCT) for haematological malignancies can cause acute and chronic graft-versus-host disease (GvHD), impacting graft success and mortality. Rabbit anti-thymocyte globulin (r-ATG) or post-transplant cyclophosphamide (PTCy) is effective in reducing GvHD in haploidentical-HSCT. This review included 17 studies to assess rATG + PTCy for GvHD prophylaxis. Overall acute GvHD grade II-IV, moderate-to-severe chronic GvHD and GvHD-free relapse-free survival rates ranged from 11.50%-35.40%, 2.90%-17.78% and 21.80%-63%, respectively. Although r-ATG + PTCy treatment lowered GvHD incidence and increased survival rates, cytomegalovirus and Epstein-Barr virus reactivation were observed; therefore, more investigations on this treatment are needed, especially on dosing and timing when used for HSCT.

Keywords: anti‐thymocyte globulin (rATG); cyclophosphamide; graft vs. host disease (GvHD); haematopoietic stem cell transplantation; haploidentical.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Diagrammatic representation of the rationale for combining r‐ATG with PTCy in patients with haplo‐HSCT. HSCT, Haematopoietic stem cell transplantation; r‐ATG, Rabbit anti‐thymocyte globulin; PTCy, Post‐transplant cyclophosphamide.
FIGURE 2
FIGURE 2
PRISMA flow diagram [23].
FIGURE 3
FIGURE 3
Incidence of grade III‐IV aGvHD and moderate cGvHD reported across the studies [1, 3, 5, 6, 8, 9, 12, 13, 15, 16, 17, 18, 19, 21, 22]. AGvHD, Acute graft‐versus‐host disease; cGvHD, Chronic graft‐versus‐host disease; GvHD, Graft‐versus‐host disease.
FIGURE 4
FIGURE 4
Primary, secondary and overall graft failure reported across the studies [3, 5, 12, 13, 15, 16, 18, 19, 20, 21].
FIGURE 5
FIGURE 5
Overall survival rate in intervention (A) and control (B) groups at 2 years and 1 year across the studies [5, 6, 8, 9, 12, 17, 18, 22].
See this image and copyright information in PMC

References

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