Comparison of anti-human T cell globulins on immune reconstitution and early infections after autologous transplant in patients with multiple sclerosis

Autologous hematopoietic stem cell transplantation is an effective therapeutic option for patients with treatment-refractory multiple sclerosis (MS) and may be considered as first line treatment in aggressive forms. Currently, a variety of conditioning and serotherapy regimens are employed across transplant centers. In this study, we compared immune reconstitution at days 30 and 100 post-transplant in MS patients undergoing AHSCT with cyclophosphamide-based conditioning, combined with in vivo T-cell depletion using either polyclonal rabbit anti-thymocyte globulin (ATG; Thymoglobulin, Genzyme-Sanofi) or rabbit anti-T-lymphocyte globulin (ATLG; Grafalon, Neovii). We observed a significantly faster immune reconstitution for CD3⁺, CD3⁺HLA-DR⁺, CD3⁺CD4⁺, CD4⁺CD45RA⁺, CD4⁺CD45RO⁺, CD3⁺CD8⁺, CD8⁺CD45RA⁺, CD8⁺CD45RO⁺, and CD4⁺CD25⁺CD127low cells in patients receiving ATLG compared to ATG at day 30 post-transplant. Although infections resulting in rehospitalization by day 180 were similarly distributed between groups, viral reactivations occurred exclusively in patients receiving ATG. No sign of high grade infectious complications or death was noted.