Comparison of different rabbit ATG preparation effects on early lymphocyte subset recovery after allogeneic HSCT and its association with EBV-mediated PTLD

Purpose Rabbit antithymocyte globulin (ATG) is commonly used before allogeneic hematopoietic stem cell transplantation (allo-HSCT) to prevent graft-versus-host disease. Studies comparing the effect of different ATG preparations and dosages on immune reconstitution and risk for Epstein–Barr virus (EBV)-mediated post-transplant lymphoproliferative disorder (PTLD) are rare. Methods In this retrospective study, we determined T and B cell subsets by flow cytometry after allo-HSCT in children, who received ATG-Genzyme (ATG-G, n = 15), ATG-Fresenius (ATG-F, n = 25) or no-ATG treatment ( n = 19). Additionally, PCR-quantified EBV-genome copy counts were correlated with incidence of PTLD. Results We could confirm a dose-dependent impairment of CD8 + and CD4 + T cell regeneration by ATG-G, including naïve and memory CD4 + T cells. No differences were seen between the currently applied dosages of 5–10 mg/kg ATG-G and 20–60 mg/kg ATG-F. Significantly delayed T cell subset reconstitution was determined only at high dosages of 20–60 mg/kg ATG-G compared to ATG-F. B cell reconstitution was comparably impaired in ATG-G- and ATG-F-treated patients. Although the incidence of EBV reactivation was similar in both ATG groups, EBV copy counts of >10 4 copies/10 5 peripheral blood mononuclear cells and the occurrence of PTLD were only found in ATG-G-treated patients. Conclusions We conclude that high, but importantly not currently applied low dosages of ATG-G, impair thymic T cell regeneration and memory T cell immunity to a greater extent than ATG-F in pediatric patients. In addition, our results suggest an increased risk for EBV-PTLD when treated with ATG-G. Prospective studies are warranted to compare different ATG preparations with regard to the immune reconstitution and EBV-PTLD.