Grafalon (Anti-T Lymphocyte Immunoglobulin For Human Use, Rabbit)

Grafalon is indicated for use in transplantation procedures where strong immunosuppression is required.

• Prevention of acute cellular rejection following kidney, liver, heart, or lung transplantation.
• Induction therapy to facilitate engraftment in allogeneic bone marrow or hematopoietic stem cell transplantation.
• Adjunctive immunosuppression in patients receiving combined organ and bone marrow transplants.
• Use as part of a desensitization protocol for highly sensitized transplant candidates.
• Management of severe cellular immune responses in experimental clinical protocols.
• Treatment of steroid‑resistant acute graft‑versus‑host disease in the early post‑transplant period.
• Supportive immunosuppression for patients undergoing ABO‑incompatible organ transplantation.

The safety profile of Grafalon includes a range of adverse events that vary in frequency and severity.

Common

• Fever, chills, or rigors during or shortly after infusion.
• Nausea, vomiting, or mild gastrointestinal discomfort.
• Transient lymphopenia with reduced T‑cell counts.
• Mild hypotension or flushing during administration.
• Headache, fatigue, or mild arthralgia occurring within the first 24 hours after infusion.
• Localized injection site reactions such as erythema, swelling, or pain.

Serious

• Severe infections, including opportunistic bacterial, viral, or fungal pathogens.
• Cytokine release syndrome presenting with high fever, hypotension, and organ dysfunction.
• Hemolytic anemia or thrombocytopenia due to immune-mediated destruction.
• Acute renal impairment or worsening of pre‑existing kidney disease.
• Development of post‑transplant lymphoproliferative disorder (PTLD) associated with uncontrolled B‑cell proliferation.
• Additional serious adverse events may include severe allergic reactions and organ dysfunction.

When prescribing Grafalon, clinicians should evaluate several precautionary factors to minimize risks and ensure appropriate patient selection.

• Assess baseline infection status and screen for latent viral infections (e.g., CMV, EBV, hepatitis B/C) before initiation.
• Evaluate renal and hepatic function, adjusting dose or monitoring closely in patients with impairment.
• Consider the patient’s immunization history; avoid live vaccines during treatment and for several weeks after.
• Review concomitant immunosuppressive agents to prevent excessive immune suppression.
• Monitor complete blood counts and lymphocyte subsets regularly throughout therapy.
• Counsel patients on signs of infection and advise prompt medical attention for fever or unexplained symptoms.

Grafalon may interact with other medications that affect immune function or increase the risk of adverse events.

Avoid

• Co-administration with other potent lymphocyte‑depleting agents (e.g., alemtuzumab, antithymocyte globulin) due to heightened immunosuppression.
• Concurrent use of live attenuated vaccines, which can cause uncontrolled infection.

Use with caution

• Calcineurin inhibitors (cyclosporine, tacrolimus) – monitor drug levels and renal function closely.
• Mycophenolate mofetil or azathioprine – adjust dosing to avoid excessive bone marrow suppression.
• Antiviral prophylaxis agents (ganciclovir, valganciclovir) – consider dose adjustments based on renal clearance.
• Corticosteroids – assess cumulative immunosuppressive burden and taper as clinically indicated.
• Concurrent nephrotoxic agents (e.g., aminoglycosides, amphotericin B) – increase monitoring of renal parameters and consider alternative therapies.