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.
Publication Date: 2013-01-15 PubMed ID: 23318980DOI: 10.1007/s00277-013-1674-8Google Scholar: Lookup
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- Comparative Study
- Journal Article
- Adult Horses
- Anemia
- Clinical Findings
- Clinical Pathology
- Clinical Study
- Comparative Study
- Diagnosis
- Disease control
- Disease Diagnosis
- Disease Etiology
- Disease Management
- Disease Prevention
- Disease Treatment
- Drug
- Equine Health
- Hematology
- Immunology
- Pharmacology
- Retrospective Study
- Veterinary Medicine
- Veterinary Practice
Summary
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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
Researcher Affiliations
- 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.
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
This article has been cited 17 times.- Yang W, Liu X, Zhao X, Zhang L, Peng G, Ye L, Zhou K, Li Y, Li J, Fan H, Yang Y, Xiong Y, Jing L, Zhang F. Antihuman T lymphocyte porcine immunoglobulin combined with cyclosporine as first-line immunosuppressive therapy for severe aplastic anemia in China: a large single-center, 10-year retrospective study.. Ther Adv Hematol 2023;14:20406207221146031.
- Hu J, Zhang L, Zhao X, Liu X, Jing L, Zhou K, Li Y, Li Y, Li J, Ye L, Peng G, Fan H, Yang W, Yang Y, Xiong Y, Song L, Zhang F. First-line immunosuppressive therapy with rATG and CsA for severe aplastic anemia: 15 years' experience.. Ann Hematol 2022 Nov;101(11):2405-2412.
- Zaimoku Y, Patel BA, Shalhoub R, Groarke EM, Feng X, Wu CO, Young NS. Predicting response of severe aplastic anemia to immunosuppression combined with eltrombopag.. Haematologica 2022 Jan 1;107(1):126-133.
- Jiang J, Cai Y, Wan L, Yang J, Wang C. Cord blood infusion-accelerated hematopoietic recovery after combined immunosuppressive therapy with fludarabine and rabbit ATG in severe aplastic anemia.. Int J Hematol 2020 Mar;111(3):360-368.
- Alzahrani N, Ashor N, Fathi T, Bukhari D, Zaher G. Idiopathic severe aplastic anemia with a delayed response to immunosuppressive therapy: a case report.. Clin Case Rep 2018 Jun;6(6):1029-1032.
- Xu L, Liu Z, Wu Y, Yang X, Cao Y, Li X, Yan B, Li S, Da W, Wu X. Clinical evaluation of haploidentical hematopoietic combined with human umbilical cord-derived mesenchymal stem cells in severe aplastic anemia.. Eur J Med Res 2018 Mar 1;23(1):12.
- Cui Q, Sha P, Chen H, Shen H, Qin L, Li Z, Wu T, Wang Z. Modified immunosuppressive therapy with porcine antilymphocyte globulin plus delayed cyclosporine A in children with severe aplastic anemia.. Int J Hematol 2018 Jan;107(1):64-68.
- Kekre N, Zhang Y, Zhang MJ, Carreras J, Ahmed P, Anderlini P, Atta EH, Ayas M, Boelens JJ, Bonfim C, Deeg HJ, Kapoor N, Lee JW, Nakamura R, Pulsipher MA, Eapen M, Antin JH. Effect of antithymocyte globulin source on outcomes of bone marrow transplantation for severe aplastic anemia.. Haematologica 2017 Jul;102(7):1291-1298.
- Hayakawa J, Kanda J, Akahoshi Y, Harada N, Kameda K, Ugai T, Wada H, Ishihara Y, Kawamura K, Sakamoto K, Ashizawa M, Sato M, Terasako-Saito K, Kimura SI, Kikuchi M, Yamazaki R, Kako S, Kanda Y. Meta-analysis of treatment with rabbit and horse antithymocyte globulin for aplastic anemia.. Int J Hematol 2017 May;105(5):578-586.
- Chuncharunee S, Wong R, Rojnuckarin P, Chang CS, Chang KM, Lu MY, Hwang WL, Koh LP, Chen TY, Leung AY, Norasetthada L, Wang SC, Chang MC, Wu KH, Issaragrisil S. Efficacy of rabbit antithymocyte globulin as first-line treatment of severe aplastic anemia: an Asian multicenter retrospective study.. Int J Hematol 2016 Oct;104(4):454-61.
- Suzuki T, Kobayashi H, Kawasaki Y, Okazuka K, Hatano K, Fujiwara S, Oh I, Ohmine K, Kanda Y. 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 2016 Oct;104(4):446-53.
- Eylem E, Yahya B, Ozlen B, Umit M, Gursel G, Ayse I, Haluk D, Salih A, Hakan G, Nilgun S, Ibrahim H, Osman O. Not all anti-T lymphocyte globulin preparations are suitable for use in aplastic anemia: significantly inferior results with jurkat cell-reactive anti-T lymphocyte globulin in clinical practice.. Int J Clin Exp Med 2015;8(9):16334-9.
- Xie X, Zhao H, Qin D, Qiao X. Pharmacokinetics and pharmacodynamics of two antithymocyte globulins in treatment of pediatric aplastic anemia.. Int J Clin Exp Med 2015;8(3):4349-55.
- Shin SH, Lee SE, Lee JW. Recent advances in treatment of aplastic anemia.. Korean J Intern Med 2014 Nov;29(6):713-26.
- Samarasinghe S, Marsh J, Dufour C. Immune suppression for childhood acquired aplastic anemia and myelodysplastic syndrome: where next?. Haematologica 2014 Apr;99(4):597-9.
- Sakamoto T, Obara N, Kurita N, Sakata-Yanagimoto M, Nishikii H, Yokoyama Y, Suzukawa K, Hasegawa Y, Chiba S. Effectiveness and safety of rabbit anti-thymocyte globulin in Japanese patients with aplastic anemia.. Int J Hematol 2013 Sep;98(3):319-22.
- Shin SH, Lee JW. The optimal immunosuppressive therapy for aplastic anemia.. Int J Hematol 2013 May;97(5):564-72.
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