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Annals of hematology2013; 92(6); 817-824; doi: 10.1007/s00277-013-1674-8

The efficacy of rabbit antithymocyte globulin with cyclosporine in comparison to horse antithymocyte globulin as a first-line treatment in adult patients with severe aplastic anemia: a single-center retrospective study.

Abstract: Antithymocyte globulin (ATG) is the drug of choice for immunosuppressive therapy (IST) in patients with severe aplastic anemia (SAA) ineligible for allogeneic stem cell transplantation. Recently, rabbit ATG with cyclosporine A has been used as a first-line IST regimen in patients with SAA because of unavailability of horse ATG. We retrospectively analyzed adult SAA patients who were treated with horse ATG (n=46) or rabbit ATG (n=53) between Feb 2001 and May 2010 to compare hematologic response and survival. Overall response rates at 3, 6, 12, and 18 months were similar in both the horse and rabbit ATG groups: 28.3 versus 35.8 % (P=0.421), 39.1 versus 45.3 % (P=0.537), 45.7 versus 49.1 % (P=0.735), and 47.8 versus 50.9 % (P=0.757), respectively. The complete response (CR) rate at 6 months in the horse ATG was significantly superior in comparison with the rabbit ATG (13.0 versus 1.9 %, P=0.031). But CR rates became similar in both groups after 6 months: 17.4 versus 11.3 % (P=0.387) at 12 months and 21.7 versus 22.6 % (P=0.914) at 18 months. Lymphocyte depletion after ATG was more profound and protracted in the rabbit ATG group compared to the horse ATG group. Overall survival (P=0.460) and failure-free survival (P=0.911) were not significantly different between the two groups. Our retrospective study demonstrated that the efficacy of first-line IST with rabbit ATG is similar to that with horse ATG. However, the time from treatment to CR was longer with rabbit ATG than with horse ATG, partly due to more profound and protracted lymphocyte depletion.
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Publication Date: 2013-01-15 PubMed ID: 23318980DOI: 10.1007/s00277-013-1674-8Google 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.

This research investigated the effectiveness of rabbit antithymocyte globulin (ATG) in comparison to horse ATG, when used in combination with cyclosporine A, for first-line treatment of severe aplastic anemia (SAA) in adults. The study, based on data from adult SAA patients treated between 2001 and 2010, confirmed that the therapeutic impact of rabbit ATG is similar to that of horse ATG, but the time taken to achieve complete response was longer with rabbit ATG due to more intense and sustained lymphocyte depletion.

Study Overview

  • The researchers conducted a retrospective study on adult patients diagnosed with severe aplastic anemia (SAA) – a condition where the bone marrow fails to make enough blood cells for the body.
  • Two sets of patients were analyzed: those treated with horse antithymocyte globulin (ATG), and those treated with rabbit ATG, both in combination with cyclosporine A.
  • The treatments were provided between February 2001 and May 2010, with 46 patients receiving horse ATG and 53 patients receiving rabbit ATG.

Hematologic Response and Survival

  • The response rates to the treatments were analyzed at 3, 6, 12, and 18 months post-treatment. The analysis showed similar results in both treatment groups.
  • Complete response rate, which essentially means the successful treatment of the condition, at 6 months was significantly higher for the horse ATG group. However, these rates were comparable in both groups after 6 months.
  • The impact of the treatment, in terms of lymphocyte depletion, was more profound and of a longer duration in the rabbit ATG group as compared to the horse ATG group.
  • Despite these differences, the overall survival rates and failure-free survival rates – which measure the length of time after treatment during which a patient lives without any complications – were not significantly different between both groups.

Conclusions

  • The researchers concluded that the therapeutic efficacy of first-line immunosuppressive therapy with rabbit ATG and cyclosporine A was similar to that with horse ATG and cyclosporine A for adult patients with SAA.
  • The only notable difference was the time taken to achieve complete response – rabbit ATG took longer, mostly due to more profound and sustained depletion of lymphocytes.

Cite This Article

APA
Shin SH, Yoon JH, Yahng SA, Lee SE, Cho BS, Eom KS, Kim YJ, Lee S, Min CK, Kim HJ, Cho SG, Kim DW, Min WS, Park CW, Lee JW. (2013). The efficacy of rabbit antithymocyte globulin with cyclosporine in comparison to horse antithymocyte globulin as a first-line treatment in adult patients with severe aplastic anemia: a single-center retrospective study. Ann Hematol, 92(6), 817-824. https://doi.org/10.1007/s00277-013-1674-8

Publication

Annals of hematology
ISSN: 1432-0584
NlmUniqueID: 9107334
Country: Germany
Language: English
Volume: 92
Issue: 6
Pages: 817-824

Researcher Affiliations

Shin, Seung-Hwan
  • Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo-Dong, Seocho-Gu, Seoul, 137-701, Republic of Korea.
Yoon, Jae-Ho
    Yahng, Seung-Ah
      Lee, Sung-Eun
        Cho, Byung-Sik
          Eom, Ki-Sung
            Kim, Yoo-Jin
              Lee, Seok
                Min, Chang-Ki
                  Kim, Hee-Je
                    Cho, Seok-Goo
                      Kim, Dong-Wook
                        Min, Woo-Sung
                          Park, Chong-Won
                            Lee, Jong Wook

                              MeSH Terms

                              • Adolescent
                              • Adult
                              • Aged
                              • Anemia, Aplastic / blood
                              • Anemia, Aplastic / drug therapy
                              • Anemia, Aplastic / mortality
                              • Anemia, Aplastic / therapy
                              • Animals
                              • Antilymphocyte Serum / administration & dosage
                              • Antilymphocyte Serum / therapeutic use
                              • Clonal Evolution
                              • Cyclosporine / administration & dosage
                              • Cyclosporine / therapeutic use
                              • Drug Evaluation
                              • Female
                              • Horses / immunology
                              • Humans
                              • Immunosuppression Therapy / methods
                              • Immunosuppressive Agents / supply & distribution
                              • Immunosuppressive Agents / therapeutic use
                              • Kaplan-Meier Estimate
                              • Lymphocyte Count
                              • Male
                              • Middle Aged
                              • Rabbits / immunology
                              • Recurrence
                              • Republic of Korea
                              • Retrospective Studies
                              • Species Specificity
                              • T-Lymphocytes / immunology
                              • Treatment Outcome
                              • Young Adult

                              Citations

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