Antithymocyte globulin, rabbit ATG (Grafalon)

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This formulation of ATG is not FDA-approved in the United States, but is commonly used in Europe, the Middle East, and Asia.

General information

Class/mechanism: Contains antibodies against T-cell markers including CD2, CD3, CD4, CD8, CD11a, CD18, CD25, CD44, CD45, Beta-2 microglobulin, HLA Class I heavy chains, and HLA-DR. Exact mechanism not understood, but may involve removing T-cells from circulation and modifying T-cell activation, migration, proliferation, and cytotoxic effects.[1]>[2][3][4]
Route: IV
Extravasation: no information

For conciseness and simplicity, currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, Medscape, UpToDate (courtesy of Lexicomp), or the prescribing information.[1]

Diseases for which it is used

History of changes in EMA indication

  • 1984-04-16: EURD

Also known as

  • Generic names: anti-thymocyte globulin (rabbit), antithymocyte globulin (rabbit), lymphocyte immune globulin (rabbit)
  • Brand names: ATG-Fresenius, Grafalon


  1. 1.0 1.1 Antithymocyte globulin, rabbit ATG (Grafalon) package insert
  2. File:Antithymocyteglobulinrabbitgrafalon.pdf
  3. Finke J, Bethge WA, Schmoor C, Ottinger HD, Stelljes M, Zander AR, Volin L, Ruutu T, Heim DA, Schwerdtfeger R, Kolbe K, Mayer J, Maertens JA, Linkesch W, Holler E, Koza V, Bornhäuser M, Einsele H, Kolb HJ, Bertz H, Egger M, Grishina O, Socié G; ATG-Fresenius Trial Group. Standard graft-versus-host disease prophylaxis with or without anti-T-cell globulin in haematopoietic cell transplantation from matched unrelated donors: a randomised, open-label, multicentre phase 3 trial. Lancet Oncol. 2009 Sep;10(9):855-64. Epub 2009 Aug 18. link to original article PubMed
  4. Kröger N, Solano C, Wolschke C, Bandini G, Patriarca F, Pini M, Nagler A, Selleri C, Risitano A, Messina G, Bethge W, Pérez de Oteiza J, Duarte R, Carella AM, Cimminiello M, Guidi S, Finke J, Mordini N, Ferra C, Sierra J, Russo D, Petrini M, Milone G, Benedetti F, Heinzelmann M, Pastore D, Jurado M, Terruzzi E, Narni F, Völp A, Ayuk F, Ruutu T, Bonifazi F. Antilymphocyte Globulin for Prevention of Chronic Graft-versus-Host Disease. N Engl J Med. 2016 Jan 7;374(1):43-53. link to original article PubMed