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International journal of hematology2016; 104(4); 446-453; doi: 10.1007/s12185-016-2046-7

Efficacy of combination therapy with anti-thymocyte globulin and cyclosporine A as a first-line treatment in adult patients with aplastic anemia: a comparison of rabbit and horse formulations.

Abstract: Anti-thymocyte globulin (ATG) is a key drug in immunosuppressive therapy for patients with aplastic anemia. The mainstay of ATG therapy had been a horse ATG (hATG) formulation, Lymphoglobulin or ATGAM, but Lymphoglobulin was recently discontinued, and Thymoglobulin, a rabbit ATG (rATG) formulation, is currently used as the first-line drug in many countries, including Japan. However, a recent randomized clinical trial reported significantly unfavorable outcomes associated with the use of rATG regimens. We retrospectively analyzed clinical outcomes of adult patients with moderate to severe aplastic anemia who were treated with 3.5 mg/kg of Thymoglobulin (n = 22) or 15 mg/kg of Lymphoglobulin (n = 25) in our facility. The estimated overall response rates in the rATG and hATG groups were 64.6 versus 56.0 % at 6 months, and 76.4 versus 69.2 % at 12 months, respectively; and there was no statistical difference between the two groups (P = 0.32). Overall survival at 24 months was not significantly different: rATG 89.8 % versus hATG 96.0 % (P = 0.39). Early phase infection was observed in 37.5 % of cases in the rATG and 14.8 % in the hATG group, but the frequency was not statistically different (P = 0.107). Our data indicate that Thymoglobulin at a dose of 3.5 mg/kg is a viable alternative when hATG is not available.
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Publication Date: 2016-06-23 PubMed ID: 27338268DOI: 10.1007/s12185-016-2046-7Google Scholar: Lookup
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  • Comparative Study
  • Journal Article

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research paper explores the use of anti-thymocyte globulin (ATG) in treating aplastic anemia in adults. It compares the efficacy of rabbit and horse formulations of ATG, with the conclusion that rabbit ATG, specifically Thymoglobulin, is a viable alternative when horse ATG, known as Lymphoglobulin, is not available.

Background

  • This research was prompted by the discontinuation of Lymphoglobulin, the horse ATG (hATG) formulation, which was primarily used for immunosuppressive therapy in patients with aplastic anemia.
  • Despite the common use of Thymoglobulin, a rabbit ATG (rATG) formulation in many countries, a past clinical trial found unfavorable results linked with the rATG regime.

Methods and Outcome Measure

  • The researchers conducted a retrospective study, analyzing the clinical outcomes of adult patients with moderate to severe aplastic anemia who were administered either Thymoglobulin or Lymphoglobulin at specific doses.
  • The response rates show that the rATG group had better response rates at 6 and 12 months, but there was no major statistical difference in comparison to the hATG group.
  • Additionally, the survival rate at 24 months showed no significant statistical difference.
  • An early phase infection was noted to be higher in patients who received rATG than hATG, although the frequency has no statistical significance.

Conclusion

  • In conclusion, the study found that Thymoglobulin at a dose of 3.5 mg/kg could be an effective alternative when Lymphoglobulin (hATG) is unavailable.
  • While the results show a slight improvement in terms of response rates with rATG, the differences were not statistically significant, suggesting that both treatments may be effective in treating aplastic anemia in adults.

Cite This Article

APA
Suzuki T, Kobayashi H, Kawasaki Y, Okazuka K, Hatano K, Fujiwara S, Oh I, Ohmine K, Kanda Y. (2016). Efficacy of combination therapy with anti-thymocyte globulin and cyclosporine A as a first-line treatment in adult patients with aplastic anemia: a comparison of rabbit and horse formulations. Int J Hematol, 104(4), 446-453. https://doi.org/10.1007/s12185-016-2046-7

Publication

International journal of hematology
ISSN: 1865-3774
NlmUniqueID: 9111627
Country: Japan
Language: English
Volume: 104
Issue: 4
Pages: 446-453

Researcher Affiliations

Suzuki, Takahiro
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Kobayashi, Hiroyuki
  • Nasu Red Cross Hospital, Otawara, Tochigi, Japan.
Kawasaki, Yasufumi
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Okazuka, Kiyoshi
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Hatano, Kaoru
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Fujiwara, Shin-Ichiro
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Oh, Iekuni
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Ohmine, Ken
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Kanda, Yoshinobu
  • Division of Hematology, Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. ycanda-tky@umin.ac.jp.

MeSH Terms

  • Adult
  • Anemia, Aplastic / drug therapy
  • Animals
  • Antilymphocyte Serum / administration & dosage
  • Cyclosporine / administration & dosage
  • Drug Therapy, Combination / methods
  • Drug Therapy, Combination / mortality
  • Drug Therapy, Combination / standards
  • Horses
  • Humans
  • Immunoglobulins / administration & dosage
  • Immunosuppressive Agents / therapeutic use
  • Rabbits
  • Treatment Outcome

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Citations

This article has been cited 11 times.
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