Rabbit antithymocyte globulin (r-ATG) plus cyclosporine and granulocyte colony stimulating factor is an effective treatment for aplastic anaemia patients unresponsive to a first course of intensive immunosuppressive therapy

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ID: 266366
1999
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Abstract
About 30% of patients with severe aplastic anaemia (SAA) unresponsive to one course of immunosuppressive (IS) therapy with antithymocyte or antilymphocyte globulin can achieve complete or partial remission after a second IS treatment. Among various second‐line treatments, rabbit ATG (r‐ATG) could represent a safe and effective alternative to horse ALG (h‐ALG). In a multicentre study, 30 patients with SAA (17 males and 13 females, median age 21 years, range 2–67) not responding to a first course with h‐ALG plus cyclosporin (CyA) and granulocyte colony stimulating factor (G‐CSF), were given a second course using r‐ATG (3.5 mg/kg/d for 5 d), CyA (5 mg/kg orally from day 1 to 180) and G‐CSF (5 μg/kg subcutaneously from day 1 to 90). The median interval between first and second treatment was 151 d (range 58–361 d). No relevant side‐effects were observed, but one patient died early during treatment because of sepsis. Overall response, defined as transfusion independence, was achieved in 23/30 (77%) patients after a median time of 95 d (range 14–377). Nine patients (30%) achieved complete remission (neutrophils 2.0 × 109/l, haemoglobin 11 g/dl and platelets 100 × 109/l). The overall survival rate was 93% with a median follow‐up of 914 d (range 121–2278). So far, no patient has relapsed. Female gender was significantly associated with a poorer likelihood to respond (P = 0.0006). These data suggest that r‐ATG is a safe and effective alternative to h‐ALG for SAA patients unresponsive to first‐line IS treatment.
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Authors E. Di Bona,F. Rodeghiero,B. Bruno,A. Gabbas,P. Foa,A. Locasciulli,C. Rosanelli,L. Camba,P. Saracco,A. Lippi,A. P. Iori,F. Porta,V. De Rossi,B. Comotti,P. Iacopino,C. Dufour,A. Bacigalupo;E. Di Bona;F. Rodeghiero;B. Bruno;A. Gabbas;P. Foa;A. Locasciulli;C. Rosanelli;L. Camba;P. Saracco;A. Lippi;A. P. Iori;F. Porta;V. De Rossi;B. Comotti;P. Iacopino;C. Dufour;A. Bacigalupo;
Journal British journal of haematology
Year 1999
DOI
10.1046/j.1365-2141.1999.01693.x
URL
https://sciprofiles.com/publication/view/f5f648a669adf7b308396d8d1fa91e05
Keywords
treatment anaemia horse globulin atg course immunosuppressive cya 109/l aplastic

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