Remission induction in a patient with severe aplastic anemia and renal failure by immunosuppressive treatment including antithymocyte globulin

1982 ◽  
Vol 45 (4) ◽  
pp. 275-278 ◽  
Author(s):  
H. G. Hartmann ◽  
H. W. Pees ◽  
G. A. Jutzler ◽  
P. G. Scheurlen
Keyword(s):  
Renal Failure ◽  
Aplastic Anemia ◽  
Antithymocyte Globulin ◽  
Immunosuppressive Treatment ◽  
Severe Aplastic Anemia ◽  
Remission Induction

Neutrophil Counts Could Predict the Response to Immunosuppressive Treatment with Antithymocyte Globulin and Cyclosporine in the Patients with Severe Aplastic Anemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4109-4109
Author(s):  
Myung Hee Chang ◽  
Dong Hwan Kim ◽  
Kyoung Ha Kim ◽  
Hee Kyung Ahn ◽  
Su Jin Lee ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Aplastic Anemia ◽  
Neutrophil Count ◽  
Predictive Factor ◽  
Antithymocyte Globulin ◽  
Immunosuppressive Treatment ◽  
Severe Aplastic Anemia ◽  
Hematopoietic Stem ◽  
Number Of Patients ◽  
Related Mortality

Abstract Background: Standard therapy in patients with severe aplastic anemia (SAA) without available HLA-matched sibling donor is immunosuppressive treatment (IST) including antithymocyte globulin (ATG) plus cyclosporine (CSA). However, the predictive marker of the response following IST is still to be fully elucidated. Methods and patients: The current study was aimed to determine the predictive factor of response to IST including ATG plus CSA for the patients with SAA, and to identify the prognostic factor of the patients following IST. Overall, 62 patients were included in the present study, who were diagnosed as SAA and received IST with either rabbit ATG (n=33) or horse ATG (n=29) plus CSA between Oct 1994 and Dec 2007. Patients’ characteristics were as follows: median age 49 years old, male:female 29:33. The dosage of ATG was as follows: rabbit ATG (Thymoglobuline®) 3.5mg/kg/day for 5 consecutive days or horse ATG (ATGAM®) 40mg/kg/day for 4 consecutive days. CSA was started at the dose of 5mg/kg/day initially, then adjusted to maintain the trough level between 150 and 400 ng/ml till day 180. CSA was tapered slowly after then. Pneumocystis jirovechi and Herpes Simplex virus prophylaxis was done. Antifungal prophylaxis was done locally and G-CSF support was not performed routinely. Results: With median follow up duration of 23 months (range, 0.5–122months), the rate of overall response (OR) was 50% (complete response (CR) 32%, 95% CI [19–44%] and partial response (PR) 18%, 95% CI [8–27%]). There was no difference of response rate between the groups receiving rabbit ATG versus horse ATG (p=0.571). The 2 year overall survival (OS) was 77±6%. Allogeneic hematopoietic stem cell transplantation (HSCT) was performed in 7 patients failing IST of whom 5 patients are alive and disease free. Another 4 patients failing IST received second line IST, but all of them failed. The IST-related mortality within 3 months was noted in 4 patients (6%). The causes of mortality were infection in all 4 cases. The only predictive factor for the response to IST was neutrophil count over 0.5×109/L prior to IST (p=0.01). Favorable prognostic factors for OS following IST was absolute reticulocyte count (ARC) over 16,000 (p=0.007, hazard ratio [HR] 0.162, 95% CI [0.036–0.727]) and an achievement of CR (p=0.02, HR 0.121 [0.015–0.959]) or OR (p=0.0001, HR 0.05 [0.006–0.396]). In a multivariate analysis for OS using Cox’s proportional hazard model, an achievement of OR was confirmed as an independent favorable prognostic factor for OS (p=0.006, HR 0.053 [0.007–0.428]). Conclusion: IST with ATG plus CSA could achieve successful outcomes in a half of SAA patients with acceptable treatment related mortality. The response to IST could be predicted by the neutrophil count of 0.5×109/L. The achievement of ORR is an independent prognostic factor for OS. However, further study is strongly warranted to reach a clear conclusion for the predictive factor for OR or OS based on a larger number of patients.

Prolonged Renal Failure Secondary to Antithymocyte Globulin Treatment in Severe Aplastic Anemia

2007 ◽  
Vol 41 (5) ◽  
pp. 895-898 ◽  
Author(s):  
Ruchdi K Barakat ◽  
Johann P Schmolck ◽  
Kevin W Finkel ◽  
John R Foringer
Keyword(s):  
Renal Failure ◽  
Aplastic Anemia ◽  
Antithymocyte Globulin ◽  
Severe Aplastic Anemia

Reduced dose cyclophosphamide, fludarabine and antithymocyte globulin for sibling and unrelated transplant of children with severe and very severe aplastic anemia

2013 ◽  
Vol 17 (4) ◽  
pp. 387-393 ◽  
Author(s):  
Nack-Gyun Chung ◽  
Jae Wook Lee ◽  
Pil-Sang Jang ◽  
Dae-Chul Jeong ◽  
Bin Cho ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Antithymocyte Globulin ◽  
Severe Aplastic Anemia ◽  
Reduced Dose

scholarly journals Multicenter randomized study comparing cyclosporine-A alone and antithymocyte globulin with prednisone for treatment of severe aplastic anemia

Blood ◽  
1992 ◽  
Vol 79 (10) ◽  
pp. 2540-2546 ◽  
Author(s):  
E Gluckman ◽  
H Esperou-Bourdeau ◽  
A Baruchel ◽  
M Boogaerts ◽  
J Briere ◽  
...  
Keyword(s):  
Partial Response ◽  
Aplastic Anemia ◽  
Antithymocyte Globulin ◽  
Bone Marrow Failure ◽  
Randomized Study ◽  
Alternative Therapy ◽  
Survival Rates ◽  
Severe Aplastic Anemia ◽  
Actuarial Survival ◽  
Significant Difference

Abstract We report the results of a randomized multicenter study comparing the efficacy of antithymocyte globulin (ATG) with that of cyclosporin A (CsA) as first-line therapy for severe aplastic anemia (SAA). Patients were randomized to receive ATG and prednisone (PDN) or CsA; hematologic response and toxicity were compared. At 3-month evaluation, patients who had no or minimal response received the alternative therapy to assess the value of a sequential immunosuppressive therapy for treatment of severe aplastic anemia. One hundred nineteen patients were randomized; 25 were excluded, of whom 3 were misdiagnosed and 22 did not follow the cross-over protocol. Ninety-four patients were analyzed; 46 received CsA, and 48 received ATG-PDN. The actuarial survival was 66.7%, with a median follow-up time of 19 months. There was no significant difference in survival between the groups with, at 3 months, an actuarial survival of 88% in the CsA group and 75% in the ATG group (NS); at 12 months, it was 70% in the CsA group and 64% in the ATG group (NS). The percentage of complete and partial response was 11.6% and 16%, respectively, at 3 months, and 31.6% and 30%, respectively, at 12 months (NS). The main prognostic factor was the absolute neutrophil count (ANC) at entry: Patients with ANC less than 0.2 x 10(9)/L had a significantly lower survival as compared with patients with more than 0.2 x 10(9)/L ANC (P = .0001). At 12 months, 62 evaluable patients were alive, with a complete or partial response in 36 patients. Patients who had responded to the first treatment had a better recovery of bone marrow failure than those who had sequential immunosuppression. The main complication was infection, which was more often observed and more often lethal during ATG and PDN therapy. In this study, initial treatment of SAA with either CsA or ATG-PDN followed by cross-over therapy for nonresponders produced comparable response and survival rates.

High-dose cyclophosphamide compared with antithymocyte globulin for treatment of acquired severe aplastic anemia

2013 ◽  
Vol 41 (4) ◽  
pp. 328-334 ◽  
Author(s):  
Fengkui Zhang ◽  
Li Zhang ◽  
Liping Jing ◽  
Kang Zhou ◽  
Huijun Wang ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Antithymocyte Globulin ◽  
Severe Aplastic Anemia ◽  
High Dose ◽  
Acquired Severe Aplastic Anemia

Low Doses of High-Potency Antithymocyte Globulin (ATG) in Severe Aplastic Anemia: Experience with the Mexican ATG

1989 ◽  
Vol 81 (2) ◽  
pp. 70-74 ◽  
Author(s):  
José Luis Delgado-Lamas ◽  
Xavier López-Karpovitch ◽  
Antonio Marín-López ◽  
Fernando Romero-García ◽  
Guillermo J. Ruiz-Argüelles ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Antithymocyte Globulin ◽  
Severe Aplastic Anemia ◽  
Low Doses ◽  
High Potency
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