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European journal of haematology2009; 84(2); 154-159; doi: 10.1111/j.1600-0609.2009.01378.x

Predictors of response to immunosuppressive therapy with antithymocyte globulin and cyclosporine and prognostic factors for survival in patients with severe aplastic anemia.

Abstract: Immunosuppressive therapy (IST) with antithymocyte globulin (ATG) plus cyclosporine (CSA) is standard therapy in patients with severe aplastic anemia (SAA) who do not have an available HLA-matched sibling donor. Methods: The current study aimed to determine the predictive factors for response to IST in patients with SAA and to identify prognostic factors following IST. A total of 62 patients diagnosed with SAA who received IST with either rabbit ATG (n = 33) or horse ATG (n = 29) plus CSA between October 1994 and December 2007 were included. Results: With a median follow-up duration of 60.5 months, complete response and overall response were estimated to be 31% and 53%, respectively. The 4 yr overall survival rate was 75 + or - 6%. In terms of predicting the response to IST, neutrophil counts above 0.3 x 10(9)/L prior to IST were the only significant predictive factor (P = 0.02). Survival following IST was significantly different in favor of both the group showing high absolute reticulocyte counts (ARC) above 10.9 x 10(9)/L prior to IST (P = 0.004) and the group achieving any response following IST (P = 0.002). Conclusions: Pre-IST neutrophil counts might predict the response to IST, while absolute ARCs prior to IST and response status after IST could be prognostic factors following IST.
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Publication Date: 2009-11-12 PubMed ID: 19912311DOI: 10.1111/j.1600-0609.2009.01378.xGoogle Scholar: Lookup
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Summary

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The research aims to identify the predictive factors for response to Immunosuppressive therapy (IST) with antithymocyte globulin (ATG) and cyclosporine (CSA) in patients with severe aplastic anemia (SAA) as well as finding out the prognostic factors after the treatment. The findings show that prior neutrophil counts could be a predictor for IST response, whereas absolute reticulocyte counts prior to IST and the response status after treatment could indicate prognosis following treatment.

Research Methodology

  • The research involved 62 patients who had been diagnosed with SAA and subsequently treated with either rabbit or horse ATG plus CSA over a period from October 1994 to December 2007.
  • The aim was to uncover any factors that could predict patient response to IST, as well as those that could help determine prognosis after IST.

Research Findings

  • Over a median follow-up period of 60.5 months, the researchers found that the complete response and overall response rates to IST were 31% and 53% respectively.
  • The overall survival rate at 4 years post-treatment was roughly 75%.
  • The research identified that a neutrophil count higher than 0.3 x 10(9)/L prior to IST treatment was a significant predictive factor in how patients responded to treatment. This was statistically significant, with a P-value of 0.02.
  • In terms of prognostic factors following IST, the study found a significant difference in favor of the group showing high absolute reticulocyte counts (ARC) above 10.9 x 10(9)/L prior to IST. This was also statistically significant with a P-value of 0.004.
  • The level of response achieved post-IST was also associated with prognosis following treatment, with a P-value of 0.002.

Conclusions

  • The research concluded that pre-IST neutrophil counts could be used as a predictive factor in response to the IST. In cases where patients had neutrophil count higher than the threshold, it was likely that they would respond better to the treatment.
  • In terms of prognostic factors following IST, patients with higher absolute reticulocyte counts prior to IST or those achieving any level of response after the treatment could have better survival outcomes.

Cite This Article

APA
Chang MH, Kim KH, Kim HS, Jun HJ, Kim DH, Jang JH, Kim K, Jung CW. (2009). Predictors of response to immunosuppressive therapy with antithymocyte globulin and cyclosporine and prognostic factors for survival in patients with severe aplastic anemia. Eur J Haematol, 84(2), 154-159. https://doi.org/10.1111/j.1600-0609.2009.01378.x

Publication

European journal of haematology
ISSN: 1600-0609
NlmUniqueID: 8703985
Country: England
Language: English
Volume: 84
Issue: 2
Pages: 154-159

Researcher Affiliations

Chang, Myung H
  • Department of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim, Kyoung H
    Kim, Hyo S
      Jun, Hyun J
        Kim, Dong H
          Jang, Jun H
            Kim, Kihyun
              Jung, Chul W

                MeSH Terms

                • Adolescent
                • Adult
                • Aged
                • Anemia, Aplastic / blood
                • Anemia, Aplastic / drug therapy
                • Anemia, Aplastic / mortality
                • Animals
                • Antilymphocyte Serum / administration & dosage
                • Cyclosporine / administration & dosage
                • Disease-Free Survival
                • Female
                • Horses
                • Humans
                • Immunosuppression Therapy / methods
                • Immunosuppressive Agents / administration & dosage
                • Leukocyte Count
                • Male
                • Middle Aged
                • Neutrophils
                • Rabbits
                • Reticulocyte Count
                • Retrospective Studies
                • Survival Rate

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