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Bone Marrow Transplantation (2003) 31, 817822
& 2003 Nature Publishing Group All rights reserved 0268-3369/03 $25.00www.nature.com/bmtPost-Transplant ComplicationsNon-overt disseminated intravascular coagulation in patients during
treatment with antithymocyte globulin for unrelated allogeneic
hematopoietic stem cell transplantationM Weber, N Kroger, F Langer, A Hansen, T Zabelina, B Eifrig, DK Hossfeld and AR ZanderDepartment of Internal Medicine II and Bone Marrow Transplantation Unit, University Hospital Hamburg-Eppendorf,
Martinistrasse 52, 20246 Hamburg, GermanySummary:We assessed the effect of rabbit antithymocyte globulin
manufactured by Fresenius (ATG-F) on the hemostatic
system in patients (n 12) with various hematological
malignancies undergoing hematopoietic stem cell transplantation (HSCT) from HLA-matched unrelated donors.
For this purpose, we monitored different parameters of
coagulation before, during and after the administration of
ATG-F. As a control group, we recruited patients (n 10)
undergoing HSCT from their HLA-identical siblings who
did not receive ATG-F as part of their preparative
regimens. At 24 and 48 h after ATG-F treatment had
been initiated, we found a temporary rise in D-Dimer,
tissue factor, soluble thrombomodulin and thrombinantithrombin III complex levels and a signicant decrease
of platelet counts in patients treated with ATG-F as
compared to the control group. No differences between the
two groups could be detected with regard to global
coagulation tests as well as the incidence of bleeding
manifestations, thromboembolic complications or the
development of vascular-occlusive-disease of the liver.
This temporary state of a stressed but compensated
coagulation system under ATG-F therapy can be addressed as nonovert disseminated intravascular coagulation (DIC). The effect was independent from the different
conditioning regimens and eased off after cessation of
ATG-F. We conclude that ATG-F can induce nonovert
DIC in patients receiving antithymocyte globulin as part
of their conditioning regimen for HSCT.Bone Marrow Transplantation (2003) 31, 817822.
doi:10.1038/sj.bmt.1703921Keywords: nonovert disseminated coagulation; antithymocyte globulin; allogeneic; hematopoietic stem cell
transplantationIntroductionIn vivo T-cell depletion with antithymocyte globulin (ATG)
as part of the conditioning regimen in patients undergoing
hematopoietic stem cell transplantation (HSCT) from
unrelated donors can be used as a strategy to lower the
incidence of acute and chronic graft-versus-host disease
(GVHD).13 Recently, our group demonstrated that ATG
Fresenius (ATG-F) leads to a signicant reduction of
GVHD without increase of relapse or graft failure in good
risk patients with myeloid leukemia after stem cell
transplantation from matched related donors.4 Different