Anti-lymphocyte globulin explained

Anti-lymphocyte globulin (ALG) is an infusion of animal- antibodies against human T cells which is used in the treatment of acute rejection in organ transplantation. Its use was first reported by Thomas Starzl in 1966.^[1] Its use in transplant was supplanted by thymoglobulin between 1984 and 1999.^[2]

It has also been used in the treatment of aplastic anemia.^{[3] [4]}

It is less commonly used than the similar anti-thymocyte globulin (ATG), and like ATG it is associated with cytokine release syndrome in the short term and an increased risk of post-transplant lymphoproliferative disorder in the long term. ALG is more likely to cause side effects than ATG, but is safer than OKT3.

The product was manufactured by Upjohn and Merieux, as well as the Schweizerisches Serum- und Impfinstitut in Bern, the latter of which was made by injecting horses with human thoracic duct lymphocytes and was called "Lymphoser Berna".^{[5] [6]}

Notes and References

1. Book: Hakim. Nadey. Danovitch. Gabriel. Transplantation Surgery. 2013. Springer Science & Business Media. 9781447136897. 11. en.
2. Verghese. PS. Dunn. TB. Chinnakotla. S. Gillingham. KJ. Matas. AJ. Mauer. MS. Calcineurin inhibitors in HLA-identical living related donor kidney transplantation.. Nephrology, Dialysis, Transplantation. January 2014. 29. 1. 209–18. 10.1093/ndt/gft447. 24414376. 3888312.
3. Kaya B, Davies CE, Oakervee HE, Silver NC, Gawler J, Cavenagh JD . Guillain Barré syndrome precipitated by the use of antilymphocyte globulin in the treatment of severe aplastic anaemia . J. Clin. Pathol. . 58 . 9 . 994–5 . September 2005 . 16126887 . 1770826 . 10.1136/jcp.2004.020354 .
4. Book: Lichtman. Marshall A.. Spivak. Jerry L.. Boxer. Laurence A.. Shattil. Sanford J.. Henderson. Edward S.. Hematology landmark papers of the twentieth century. 2000. Academic Press. San Diego. 978-0-12-448510-5. 709–714. Commentary on and reprint of Speck B, Gluckman E, Haak HL, van Rood JJ, Treatment of aplastic anaemia by antilymphocyte glubulin with and without allogeneic bone marrow infusions, in Lancet (1977) 2:1145–1148. 10.1016/B978-012448510-5.50159-X.
5. Frickhofen . N. Kaltwasser . JP. Schrezenmeier . H. Raghavachar. A. Vogt . HG . Herrmann . F. Freund . M. Meusers. P. Salama. A. Heimpel. H. Treatment of aplastic anemia with antilymphocyte globulin and methylprednisolone with or without cyclosporine. The German Aplastic Anemia Study Group.. The New England Journal of Medicine. 9 May 1991. 324. 19. 1297–304. 10.1056/NEJM199105093241901. 2017225. free.
6. Speck. B. Gratwohl. A. Nissen. C. Osterwalder. B. Würsch. A. Tichelli. A. Lori. A. Reusser. P. Jeannet. M. Signer. E. A comparison between ALG and bone marrow transplantation in treatment of severe aplastic anemia.. Thymus. 1987. 10. 1-2. 147–58. 3324403.