Summary:Antithymocyte globulin (ATG) is accepted as a treatment option for steroid-refractory acute graft-versushost disease (GVHD). We conducted an international survey to determine how steroid refractoriness is defined and how ATG is used in clinical practice. Responses were received from 153 centers in 36 countries. The most common threshold steroid dose to define steroid refractoriness was 2 mg/kg/day (67% of respondents), and the median duration of treatment before failure was declared varied from 3 to 5.5 days, depending on whether failure was defined as 'progressed', 'not improved' or 'not resolved'. The threshold corticosteroid dose was significantly higher in pediatric centers than in adult or combined programs (P = 0.003). ATG was used routinely for treatment of steroid-refractory GVHD by 67% of the respondents. Horse ATG was used more frequently than rabbit ATG overall (50% vs 24%, P Ͻ 0.001), and predominance of horse ATG was most evident in the western hemisphere, in small-to medium-sized centers, and in pediatric centers. A wide variety of dose schedules for both drugs was reported. We conclude that there is some degree of variation in the definition of steroid refractoriness, especially between pediatric and nonpediatric programs, and no consensus has emerged in identifying the optimal ATG dose schedule in this setting. Bone Marrow Transplantation (2001) 28, 945-950. Keywords: graft-versus-host disease; treatment; antithymocyte globulin; antilymphocyte globulin; steroid-refractory; pediatric Antithymocyte globulin (ATG) was first introduced as a therapy for acute GVHD in 1974.1 Several single-agent ATG dose schedules or combination regimens that include horse or rabbit ATG have been evaluated in this setting, [1][2][3][4][5][6][7][8][9][10] and the activity demonstrated by these regimens enabled acceptance of ATG as a standard treatment for steroidrefractory acute GVHD. In the evaluation of new immuno-
Transposon Tn5 mutagenesis of the Escherichia coli chromosome was used to isolate 21 independent insertion mutations conferring an altered colony color phenotype on MacConkey-glycerol plates. The polymerase chain reaction was used to map 16 of these Tn5 insertions within the glpFK region at 88 min. The most polar Tn5 insertion was shown by nucleotide sequencing to be in the proposed glpF open reading frame. The data suggest that the glpF and glpK genes are in an operon with a bent DNA segment (BENT-6) involved in transcriptional regulation of this operon.
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