American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary method to prevent chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation?

1. High-dose chemotherapy

2. Anti-T-lymphocyte immune globulin

3. Corticosteroids

4. Monoclonal antibody therapy

The correct answer is: Anti-T-lymphocyte immune globulin

The primary method to prevent chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation is the use of anti-T-lymphocyte immune globulin. This therapy works by depleting or inhibiting T-lymphocytes from the donor graft before they can mount an immune response against the recipient's tissues, which is the underlying mechanism of cGVHD. By reducing the number and activity of these T cells, the likelihood of the donor's immune cells attacking the host's organs and tissues is significantly lowered. While high-dose chemotherapy, corticosteroids, and monoclonal antibody therapies can be part of the overall management strategy for transplant patients or for treating established cGVHD, they are not specifically used as primary prophylactic measures to prevent the onset of the disease in the first place. High-dose chemotherapy may be used for conditioning before transplantation, but it does not directly prevent cGVHD. Corticosteroids are typically employed when cGVHD has already developed, offering immunosuppressive effects that may help manage symptoms. Monoclonal antibody therapy could also be used for therapy, but it is not as foundational in the prevention of cGVHD as anti-T-lymphocyte immune