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This is a combination immunosuppressive regimen used primarily for prevention of graft-versus-host disease (GVHD) in patients undergoing unrelated hematopoietic stem cell transplantation. The combination works through multiple mechanisms to prevent rejection and GVHD. Anti-thymocyte globulin (ATG) is a polyclonal antibody preparation that targets T cells, leading to T-lymphocyte depletion via complement-mediated cytotoxicity or apoptosis. Sirolimus (also known as rapamycin) inhibits the mammalian target of rapamycin (mTOR), affecting T cell proliferation and can expand regulatory T cells. Tacrolimus prevents T-lymphocyte activation by binding to FK506 binding protein and inhibiting calcineurin. Clinical studies have shown this combination is associated with a low incidence and severity of both acute and chronic GVHD in unrelated donor transplantation.
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