Treatment of aplastic anemia with an investigational antilymphocyte serum prepared in rabbits.
Abstract: The authors evaluated antilymphocyte serum prepared in rabbits (ALS-R) as an alternative to antilymphocyte serum prepared in horses (ALG-H) in the therapy of aplastic anemia. Between 1980 and 1993, 57 evaluable patients received ALS-R and prednisone +/- cyclosporine +/- androgens. Standard response criteria were used and patients were evaluated at 3 months from the start of therapy. Median age was 43 years. Disease was present for up to 2 months in 24 patients, 2-5 months in 14 patients, and 6 months or more in 19 patients. Disease was severe in 30 patients and moderate in 27. Responses occurred in 16 (28%) of 57 patients. Responses were more frequent in females, in patients treated within 6 months of diagnosis, and in patients with severe disease. Among patients receiving ALS-R and cyclosporine within 2 months of diagnosis, 46% responded. After ALS-R therapy, 20 patients received ALG-H; 8 (40%) of 20 responded. Eight patients receiving ALS-R previously had received ALG-H; 2 (25%) of these 8 patients responded. Toxicity of ALS-R was minimal. Antilymphocyte serum prepared in rabbits, in conjunction with other immunosuppressive agents, represents an effective alternative to ALG-H in aplastic anemia, especially in patients previously treated with ALG-H.
Publication Date: 1994-12-01 PubMed ID: 7985721DOI: 10.1097/00000441-199412000-00005Google Scholar: Lookup
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- Clinical Trial
- Clinical Trial
- Phase II
- Journal Article
Summary
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The researchers explored the use of a new antilymphocyte serum derived from rabbits (ALS-R) to treat aplastic anemia, comparing it to the previous standard treatment using antilymphocyte serum from horses (ALG-H). The findings showed that ALS-R therapy was effective and well-tolerated, and seems to be a promising alternative to ALG-H, especially for patients who had previously been treated with ALG-H.
Procedure and Patient Characteristics
- The study spans from 1980 to 1993, during which 57 patients with aplastic anemia were treated with ALS-R, often alongside other immune-suppressing agents such as prednisone, cyclosporine, and sometimes androgens.
- Patient ages averaged at 43 years, and the disease duration at the start of the study varied, with up to 2 months in 24 patients, 2-5 months in 14 patients, and 6 months or more in 19 patients.
- There was a variation in disease severity too, with 30 patients having a severe form and 27 with a moderate form of aplastic anemia.
Results and Analysis
- Of the 57 patients treated, 16 (or 28%) showed responses to the treatment. Females, patients with severe disease, and those treated within 6 months of diagnosis showed a higher frequency of responses.
- When ALS-R was combined with cyclosporine and administered within 2 months of diagnosis, the response rate increased to 46%.
- After ALS-R therapy, 20 patients received ALG-H, out of which 40% responded positively. Eight patients who had been treated with ALG-H before receiving ALS-R showed a response rate of 25%.
- Importantly, the study found that the toxicity of ALS-R was minimal, indicating that it is well-tolerated by patients.
Conclusion
- The study concludes that ALS-R, when used with other immune suppressant drugs, is an effective alternative to standard ALG-H therapy for aplastic anemia. This is especially true for patients who had already been treated with ALG-H, making ALS-R a potentially better and safer choice for this group of patients.
Cite This Article
APA
Stein RS, Means RT, Krantz SB, Flexner JM, Greer JP.
(1994).
Treatment of aplastic anemia with an investigational antilymphocyte serum prepared in rabbits.
Am J Med Sci, 308(6), 338-343.
https://doi.org/10.1097/00000441-199412000-00005 Publication
Researcher Affiliations
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, TN 37232.
MeSH Terms
- Adolescent
- Adult
- Aged
- Anemia, Aplastic / drug therapy
- Anemia, Aplastic / mortality
- Anemia, Aplastic / therapy
- Animals
- Antilymphocyte Serum / adverse effects
- Antilymphocyte Serum / isolation & purification
- Antilymphocyte Serum / therapeutic use
- Combined Modality Therapy
- Cyclosporine / therapeutic use
- Female
- Horses
- Humans
- Male
- Middle Aged
- Rabbits
- Survival Rate
- Time Factors
Citations
This article has been cited 2 times.- Miura K, Hatta Y, Kobayashi S, Iriyama Y, Takei K, Takeuchi J. Feasibility and eligibility of retreatment with rabbit anti-T lymphocyte globulin for aplastic anemia previously treated with horse anti-thymocyte globulin. Int J Hematol 2009 Oct;90(3):426-428.
- Luo D, Qu Y, Wang D, Zhang B, Sun M, Xiong H, Lu J, Yang R, Zhao M, Liu H, Jiang H. Comparison of upfront haploidentical hematopoietic stem cell transplantation and salvage haploidentical hematopoietic stem cell transplantation after immunosuppressive therapy in children with acquired severe aplastic anemia - a multicenter study. Front Immunol 2024;15:1384640.
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