Letter to the Editor regarding Superior GRFS in Matched Unrelated Donor HSCT with ATG compared to MRD without ATG.

Abstract The use of anti T-cell globulin (ATG) in allogeneic stem cell transplantation with matched unrelated donors (MUD) is considered standard of care in many transplant centers, as these patients are at higher risk of developing acute and chronic graft versus host disease (GvHD). Several publications have reported reduced incidence of chronic GvHD compared to matched related donors (MRD). This may support the idea of introducing ATG in prospective clinical trials, also in MRD, in an effort to reduce the long-term complications with moderate and severe GvHD. We retrospectively analyzed 169 patients, where ATG was given to patients transplanted with MUD (n=124) and not to MRD (n=45). The incidence aGVHD II-IV and III-IV was significantly lower in the MUD group compared to MRD (28.2% vs 51.3% and 8.1% vs 24.7%). Extensive chronic GvHD incidence was 5% vs 40%. Our results further support the rationale for examining the efficacy of ATG in MRD in prospective randomized trials.