Advances in umbilical cord transplantation: the role of thymoglobulin/ATG in cord blood transplantation

Umbilical cord blood transplantation (UCBT) is increasingly being used as an alternative to conventional allogeneic stem cell transplantation. However, despite significant improvements, an appreciable proportion of patients (especially adults) receiving UCBT will still face some form of severe acute and/or chronic graft-versus-host disease (GVHD). Moreover, poor engraftment and delayed immune recovery are still challenging issues. Therefore, in terms of both GVHD and engraftment kinetics, the immunosuppressive potency of the conditioning regimen prior to UCBT may play an important role. Anti-thymocyte globulin (ATG, Thymoglobulin™) provides multifaceted immunomodulation suggesting that the use of ATG may be of interest towards improving engraftment and GVHD outcome. However, the role of ATG in UCBT is still under debate. This report will review the incidence and severity of GVHD after UCBT, and will discuss the potential role of ATG towards improving outcome (GVHD and engraftment) when used as part of the conditioning regimen prior to UCBT.