![]() This reduces the risk of rejection, while similarly depleting newly infused donor T cells, thus potentially reducing GVHD, GVL, and the passive transfer of memory T cells that reconstitute early immunity. The use of antithymocyte globulin (ATG) reflects a form of in vivo T-cell depletion, which concomitantly depletes host T cells that have survived the conditioning regimen. It is generally accepted that preventing GVHD is more effective than treating it once it has been established. It was not surprising then that early on we discovered that ex vivo T-cell depletion could prevent or minimize GVHD, but at the cost of increases in mortality from rejection, relapse, and opportunistic infection. Despite recognizing that donor T cells are critical in the establishment of both acute and chronic GVHD, it is important to remember that these cells also help in preventing opportunistic infections and providing a graft-versus-leukemia (GVL) effect when necessary. ![]() ![]() Achieving this goal requires supporting the patient through a conditioning regimen and its associated toxicity, opportunistic infections, and GVHD while avoiding relapse. 1 The primary goal of HSCT is to cure the underlying hematological disorder with as little residual disability as possible. Despite improvements in HLA matching, quality control measures, and supportive care used in hematopoietic stem cell transplantation (HSCT), graft-versus-host disease (GVHD) remains a common cause of morbidity and mortality in transplant recipients.
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