REVIEW article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1634157
This article is part of the Research TopicEmerging Targeted and Immunotherapeutic Strategies in Oncology: From Solid Tumors to Hematologic MalignanciesView all articles
Optimizing anti-thymocyte globulin dosing in allogeneic hematopoietic stem cell transplantation: individualized approaches and clinical implications
Provisionally accepted
- 1Medical Innovation Research Division, Fourth Medical Center of PLA General Hospital, Beijing, China
- 2Senior Department of Hematology, Fifth Medical Center of the PLA General Hospital, Beijing, China
- 3Department of Emergency medicine, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
- 4Medical school of Chinese PLA, Beijing, China
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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a potentially curative therapy for hematologic malignancies. However, the initial clinical experience with allo-HSCT revealed a concerning prevalence of severe graft-versus-host disease (GVHD) and graft failure. Subsequent randomized studies highlighted the role of antithymocyte globulin (ATG) in reducing acute and chronic GVHD and graft failure, although it did not improve overall survival. Pharmacodynamic studies have established an association between ATG concentration and the incidence of GVHD and life-threatening infections. However, ATG concentration at designated timepoints showed no such correlations with non-relapse mortality and overall survival in allo-HSCT. There is a delicate balance between ATG exposure and the outcomes of allo-HSCT. More specifically, insufficient ATG exposure may diminish its function on GVHD prophylaxis, while excessive ATG may delay immune reconstitution and increase risk of disease relapse and infection. Considering the significant interindividual heterogeneity in ATG pharmacokinetics, individualized ATG dosing could potentially increase the proportion of transplant recipients attaining the optimal ATG exposure. Recent studies have shown that individualized ATG dosing, guided by absolute lymphocyte count or therapeutic drug monitoring, can improve optimal exposure attainment rate. Which indicated a potential approach to achieve superior transplant outcomes. This review summarizes the advances and the challenges of individualized ATG dosing in allo-HSCT.
Keywords: Anti-thymocyte globulin, graft-versus-host disease, Hematopoietic Stem Cell Transplantation, individualized dosing, Therapeutic drug monitoring
Received: 23 May 2025; Accepted: 23 Jul 2025.
Copyright: © 2025 Wang, Yang, JiShan, Dou and Liu. 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: Dai-Hong Liu, Medical school of Chinese PLA, Beijing, China
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