ATG + cyclosporine
Chemotherapy:ATG
Antithymocyte Immunoglobulin Rabbit (商品名：Thymoglobuline 25mg/vial) 2.5mg/kg/day in N/S 500 ml IVD 12 hrs QD on D1-D5
Steroid protocol 1--traditional
Methylprednisolone 5mg/kg/day in N/S 50 ml IVD 30mins QD on D1-D5
Methylprednisolone 2.5mg/kg/day in N/S 50 ml IVD 30mins QD on D6-D10
Taper steroid since D11 and discontinue on D30
Steroid protocol 2—according to Japan study
Prednisolone 1 mg/kg/day on D1~D9
Prednisolone 0.5 mg/kg/day on D10~D15
Prednisolone 0.2 mg/kg/day on D16~D21
Other medications:
Cyclosporin-A (100 mg/cap, 25 mg/cap) 2.5mg/kg/dose PO BID since D6
# suggest tapering very slowly since 12th month, 10% reduction/month (according to Italian study)
G-CSF 5 mcg/kg/day QD sc since D6 till pass nadir or failure
# suggest QD on D6~D28, Q1wk on D29~D84 (according to Japan study)
Pre-medication:
Vena 1Amp IV before Thymoglobuline○R QD on D1-D5
Tinten 1# PO before Thymoglobuline○R QD on D1-D5
Others:
Check Cyclosporin level qw1, target CsA:150~200
Consider CMV DNA rt-PCR monitoring
Consider PJP prophylaxis
Consider antacid or PPI use during steroid usage
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