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A combination of two lymphocyte-depleting biologics used off-label in transplant conditioning and graft-versus-host disease prophylaxis/treatment and in certain rejection settings. Alemtuzumab is a humanized monoclonal antibody against CD52 that depletes T and B lymphocytes (and other CD52-expressing leukocytes) primarily via antibody-dependent cellular cytotoxicity and complement-mediated lysis, producing prolonged lymphocyte depletion and immunomodulation. Anti-thymocyte globulin (ATG; typically rabbit-derived) is a polyclonal antibody preparation targeting multiple T-cell and other leukocyte antigens, inducing T-cell depletion through complement-dependent cytotoxicity, antibody-dependent cellular cytotoxicity, apoptosis, and functional modulation of adhesion/chemokine receptors. The combination may be used where profound T-cell depletion and GVHD prevention are desired, acknowledging additive immunosuppression and infection risk.
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