CASE REPORT article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1610071
Successful treatment of steroid-and ruxolitinib-refractory gastrointestinal acute graft-versus-Host disease with anti-thymocyte globulin
Provisionally accepted
- Department of Hematology, The Second Hospital of Anhui Medical University, Hefei, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Acute graft-versus-host disease (aGVHD), particularly with gastrointestinal (GI) involvement, remains a lifethreatening complication after allogeneic hematopoietic stem cell transplantation (HSCT). Despite corticosteroids and ruxolitinib as first-and second-line therapies, up to 50% of patients develop refractory disease, with limited evidence guiding third-line interventions. Anti-thymocyte globulin (ATG), historically used in conditioning regimens, has shown variable efficacy in steroid-refractory aGVHD, but its role in patients previously exposed to ATG prophylaxis remains underexplored. Here, we report the case of a 19year-old male with severe steroid-and ruxolitinib-refractory GI aGVHD, successfully treated with low-dose antithymocyte globulin (ATG) after failing multiple therapies (mycophenolate mofetil, anti-CD25 monoclonal antibody, mesenchymal stem cells, and methotrexate). This case underscores that, despite the prior use of ATG in the conditioning regimen and the multitude of available treatment options for refractory aGVHD, ATG can still be considered as a viable salvage therapy in situations where certain newer agents are not accessible.
Keywords: Allogeneic hematopoietic stem cell transplant (HSCT), acute GVHD, gastrointestinal acute GVHD, Anti-thymocyte globulin, Graft-versus-host
Received: 11 Apr 2025; Accepted: 08 Jul 2025.
Copyright: © 2025 Zhang, Wu, Wang, Zhai and Tao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Lili Tao, Department of Hematology, The Second Hospital of Anhui Medical University, Hefei, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.