Myeloablative regimens were used in 34% of cases, the rest receiving reduced intensity conditioning (RIC). Forty-four percent received in vivo T cell depletion with anti-thymocyte globulin (ATG, Thymoglobulin, Genzyme, Cambridge, MA, USA) (n = 295) or Campath® (n = 30). Patients at Karolinska (center A) received ATG (Thymoglobulin, Genzyme, Cambridge, MA, USA) at a dose of 4–8 mg/kg. Patients from Salamanca and Sant Pau (centers B and C) received ATG at a dose of 7.5 mg/kg. ATG was administered for 3–4 days with the last dose given on day 1 or 2. ATG was administered to patients with unrelated donors, HLA-mismatched donors, and those with non-malignant diseases.
Thymoglobulin
Manufactured by Sanofi
Sourced in United States, France, Canada, Germany, Ireland, Switzerland
Thymoglobulin is a polyclonal antithymocyte globulin (ATG) product developed by Sanofi. It is a sterile, purified, and concentrated immunoglobulin preparation derived from the plasma of horses immunized with human thymocytes. Thymoglobulin is used as an immunosuppressant to prevent and treat acute rejection in organ transplantation.
Automatically generated - may contain errors
Lab products found in correlation
Simulect, by Novartis (17 mentions)
Cellcept, by Roche (7 mentions)
Prograf, by Astellas Pharma (5 mentions)
Neoral, by Novartis (4 mentions)
Myfortic, by Novartis (4 mentions)
Zenapax, by Roche (3 mentions)
Atg f, by Fresenius (2 mentions)
Sandimmune, by Novartis (2 mentions)
Campath, by Sanofi (2 mentions)
Cytogam, by CSL Behring (1 mentions)
Myfenax, by Teva Pharmaceuticals (1 mentions)
Belatacept, by Bristol-Myers Squibb (1 mentions)
Imuran, by GlaxoSmithKline (1 mentions)
Anti cd20, by Roche (1 mentions)
Rituximab, by Roche (1 mentions)
Atg g, by Sanofi (1 mentions)
Labscreen, by Thermo Fisher Scientific (1 mentions)
Labscan 100, by Thermo Fisher Scientific (1 mentions)
Basiliximab, by Novartis (1 mentions)
Rapamune, by Pfizer (1 mentions)
79 protocols using thymoglobulin
1
Conditioning Regimens and T-cell Depletion
2
Induction and Maintenance Immunosuppression in Kidney Transplantation
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The induction immunosuppressive regimen consisted of a biologic induction agent (ie, basiliximab 20 mg on days 0 and 4 [Simulect; Novartis Pharma, Basel, Switzerland]) or a 5- to 8-day course of rabbit thymoglobulin, 75 mg/d (thymoglobulin; Genzyme, Saint-Germain-en-Laye, France) and intravenous corticosteroids (methylprednisolone 500 mg on day 0 and 125 mg on day 1) relayed by oral tapered corticosteroids. The maintenance immunosuppression included a calcineurin inhibitor (tacrolimus or cyclosporine), azathioprine (2 mg/kg daily), or mycophenolate mofetil (MMF) (1 g twice per day) or mycophenolate sodium (720 mg twice per day) and prednisone. The doses were adjusted to obtain blood concentrations for the appropriate objectives, according to the delay from the graft. After 2006, patients with pretransplant donor-specific antibodies also received intravenous immunoglobulins (2 g/kg) on posttransplantation days 1, 21, 42, and 63, and some patients also underwent plasmapheresis.
All patients were given Pneumocystis jirovecii prophylaxis (trimethoprim-sulfamethoxazole) for 3 to 12 months after transplantation, CMV prophylaxis (valacyclovir 1.5 g 4 times per day until 2006, and then valganciclovir 450 mg daily for 3 to 6 months).
All patients were given Pneumocystis jirovecii prophylaxis (trimethoprim-sulfamethoxazole) for 3 to 12 months after transplantation, CMV prophylaxis (valacyclovir 1.5 g 4 times per day until 2006, and then valganciclovir 450 mg daily for 3 to 6 months).
3
Induction Immunosuppression in Kidney Transplantation
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In this retrospective clinical review, most of the kidney recipients were found to have received induction immunosuppression therapy with the polyclonal rabbit anti-thymocyte globulin (rATG) Thymoglobulin®, 2–4 mg/kg for between 5–7 days (Genzyme, Cambridge, MA, USA), or the mouse anti-human monoclonal antibody to interleukin (IL)-2 receptor (CD25), basiliximab, (Simulect®) (Novartis, Basel, Switzerland) 20 mg twice at day 0 and at day 4. The rATG was primarily used in sensitized patients with antibodies, in patients with repeated transplantation, and kidney transplants with a long cold ischemia time. All patients received similar triple maintenance immunosuppressive therapy, consisting of tacrolimus, mycophenolate mofetil, and steroids. No desensitization treatment or minimization of immunosuppression treatment were used in this study.
4
Immunosuppression Regimens for Kidney Transplants
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The main immunosuppressive regimen consisted of basiliximab as an induction agent, and maintenance immunosuppressants consisted of a combination of a calcineurin inhibitor (tacrolimus or cyclosporine), mycophenolic acid, and prednisolone. As another option, recipients (n=112) with immunologic risk factors (highly sensitized patients or re-transplant recipients) and those with complications due to long-term use of steroids received rabbit anti-thymocyte globulin (Thymoglobulin®; Genzyme, Cambridge, MA, USA) as an induction regimen, and maintenance immunosuppression included tacrolimus, mycophenolic acid, and early steroid withdrawal in a week. In a case of ABO-incompatible KT, rituximab was used for desensitization 2 weeks before transplantation. The maintenance immunosuppression regimen was not different from those in ABO-compatible KT.
5
Conditioning Regimens and GVHD Prophylaxis in Hematopoietic Cell Transplantation
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The conditioning regimens used in this study included two standard myeloablative regimens (busulfan + cyclophosphamide (BuCY) and total body irradiation + CY (TBI + CY)) and a sequential intensified regimen (fludarabine + Ara-C plus TBI + Cy + etoposide) as previously described [7 (link), 11 (link), 12 (link)]. Conditioning selection was based on disease type and status at transplantation. Generally, patients with acute myeloid leukemia in complete remission (CR) were given BuCY, those with acute lymphoblastic leukemia in CR were given TBI + CY, and those in non-CR were administered the intensified regimen. In addition, some high-risk patients received the intensified regimen [7 (link), 11 (link), 12 (link)].
Cyclosporin A (CsA) plus methotrexate (MTX) (on days + 1, + 3, + 6) was administered to patients who underwent a matched sibling donor (MSD) transplant for GVHD prophylaxis. CsA + MTX + thymoglobulin (ATG; Genzyme, Cambridge) was used for patients who underwent a matched unrelated donor (MUD) transplant for GVHD. The CsA + MTX + ATG + mycophenolate (MMF) combination was administered to patients who underwent haploidentical donor (HID) transplant [7 (link), 11 (link), 12 (link)].
Cyclosporin A (CsA) plus methotrexate (MTX) (on days + 1, + 3, + 6) was administered to patients who underwent a matched sibling donor (MSD) transplant for GVHD prophylaxis. CsA + MTX + thymoglobulin (ATG; Genzyme, Cambridge) was used for patients who underwent a matched unrelated donor (MUD) transplant for GVHD. The CsA + MTX + ATG + mycophenolate (MMF) combination was administered to patients who underwent haploidentical donor (HID) transplant [7 (link), 11 (link), 12 (link)].
6
GVHD Prophylaxis in Allogeneic Stem Cell Transplantation
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All patients received conventional regimen such as myeloablative/reduced-intensity conditionings, and were classified based on criteria described by Giralt et al. [12 (link)]. Cyclosporine A (CsA) + mycophenolate mofetil (MMF) + a short course of methotrexate (MTX) were administered to the patients undergoing human leukocyte antigen (HLA)-matched sibling donor (MSD) transplant for GVHD prophylaxis. After January 2019, CsA + MMF + MTX + anti-thymocyte globulin (ATG) (ThymoglobulinⓇ, Genzyme, Cambridge, MA) were administered for 1.5 mg/kg i.v. on day-3, -2 and -1 to the MSD transplant patients whose age ≥ 45 years, and CsA + MMF + MTX + ATG (2.5 mg/kg i.v. on day-4, -3, -2 and -1) were administered to the patients undergoing haploidentical donor [13 (link)] transplants for GVHD prophylaxis, some haploidentical recipients received transplant cyclophosphamide 50 mg/kg on day + 3.
7
Comprehensive Induction Immunosuppression for Islet Transplantation
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Induction immunosuppression included a regimen with anti-human CD154 monoclonal antibody, sirolimus (Rapamune®, Wyeth), and anti-thymocyte globulin (ATG, Thymoglobulin®, Genzyme). Sirolimus was administered daily to achieve stable trough levels between 3 and 8 ng/ml. CVF (100 U/kg, Quidel) was administered on day -1 of the transplant to prevent complement activation. TNF-α neutralizing monoclonal antibody, adalimumab (Humira®, Abbott Laboratories Ltd., Queenborough, UK) was administered subcutaneously 2~3 hrs before islet infusion with dose of 5 mg/kg. 106 to 107ex-vivo expanded regulatory T cells were adoptively transferred after ATG depletion.
8
Kidney Transplant Immunosuppression Evolution
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When we started performing KT at our center in 1990, we used an immunosuppressive regimen consisting of cyclosporin, corticosteroids, and azathioprine without an induction drug. Since the mid-1990s, we have increased the usage of tacrolimus as a CNI, and more than 80% of recent transplant recipients have received tacrolimus. Azathioprine is no longer in use and has been replaced by mycophenolic acid. Patients have received basiliximab (Simulect, Novartis, East Hanover, NJ, USA) as an induction therapy since 1999. Recently, we have used rabbit antithymocyte globulin (Thymoglobulin, Genzyme, Cambridge, MA, USA) in highly sensitized recipients. In ABO-incompatible and crossmatch-positive KT, recipients receive a single dose of rituximab (200–500 mg) 2–3 weeks before transplantation and plasmapheresis with/without IVIG according to the desensitization protocol of our center [5 (link)].
9
Graft-versus-host Disease Prophylaxis Protocols
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As indicated in our previous studies (15 (link), 22 , 23 ), ciclosporin A (CsA) and methotrexate (MTX) were administered to patients undergoing MSD transplantation for GVHD prophylaxis, and mycophenolate mofetil (MMF) was added to GVHD prophylaxis of MSD transplantation from June 2013. CsA + MTX + ATG (Thymoglobulin; Genzyme, Cambridge, MA, USA) (total ATG dose, 7.5 mg/kg on days -3 to -1) were administered to patients undergoing MUD transplantation, and CsA + MTX + ATG (total ATG dose, 7.5 or 10 mg/kg on days -3 to 0) + MMF were administered to patients undergoing HID transplantation for GVHD prophylaxis. ATG (total ATG dose, 4.5 mg/kg on days -3 to -1) was applied to a minority of MSD-SCT recipients (12 (link)).
10
Conditioning Regimen for Pediatric Transplant
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At 21 days prior to transplant, all children received a single 1-hour intravenous infusion of 131I-MIBG (18 mCi/kg) with potassium iodide for thyroid protection and intravenous hydration. A cyclophosphamide (cyclophosphamide 60 mg/kg on days -7 and -6) + fludarabine (30 mg/m2 on days -5 to -1) + rabbit anti-thymocyte globulin (Thymoglobulin, Genzyme; 2.5 mg/kg on days -4 to -1) regimen was used for conditioning.
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