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Cyclophosphamide and anti-thymocyte globulin (ATG) is a combination immunosuppressive regimen primarily used in allogeneic hematopoietic stem cell transplantation (HSCT). This combination works synergistically to prevent graft-versus-host disease (GVHD) and graft rejection. Cyclophosphamide, when administered post-transplant (PT-Cy), targets alloreactive T cells while sparing regulatory T cells. ATG binds to multiple T-cell specific antigens, leading to T-lymphocyte cell death via complement-mediated cytotoxicity or apoptosis. The combination has shown effectiveness in various transplant settings, including haploidentical, unrelated donor, and matched sibling donor transplants.
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