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Clinical Trial
. 2011 Sep;96(9):1269-75.
doi: 10.3324/haematol.2011.042622. Epub 2011 May 23.

Efficacy of rabbit anti-thymocyte globulin in severe aplastic anemia

Manuel G Afable 2nd  1 , Mohammed Shaik, Yuka Sugimoto, Paul Elson, Michael Clemente, Hideki Makishima, Mikkael A Sekeres, Alan Lichtin, Anjali Advani, Matt Kalaycio, Ramon V Tiu, Christine L O'Keefe, Jaroslaw P Maciejewski
Affiliations
Clinical Trial

Efficacy of rabbit anti-thymocyte globulin in severe aplastic anemia

Manuel G Afable 2nd et al. Haematologica. 2011 Sep.

Abstract

Background: A combination of horse anti-thymocyte globulin and cyclosporine produces responses in 60-70% of patients with severe aplastic anemia. We performed a phase II study of rabbit anti-thymocyte globulin and cyclosporine as first-line therapy for severe aplastic anemia.

Design and methods: Twenty patients with severe aplastic anemia treated with rabbit anti-thymocyte globulin were compared to 67 historical control cases with matched clinical characteristics treated with horse anti-thymocyte globulin.

Results: Response rates at 3, 6 and 12 months were similar for patients treated with rabbit anti-thymocyte globulin or horse anti-thymocyte globulin: 40% versus 55% (P=0.43), 45% versus 58% (P=0.44) and 50% versus 58% (P=0.61), respectively. No differences in early mortality rates or overall survival were observed. We then performed multivariable analyses of response at 6 months and overall survival and identified the presence of a paroxysmal nocturnal hemoglobinuria clone (P=0.01) and a pretreatment absolute reticulocyte count greater than 30×10(9)/L (P=0.007) as independent predictors of response and younger age (P=0.003), higher pretreatment absolute neutrophil (P=0.02) and absolute lymphocyte counts (P=0.03) as independent predictors of overall survival. None of the immunogenetic polymorphisms studied was predictive of response to immunosupressive therapy.

Conclusions: Despite reports suggesting differences in biological activity of different anti-thymocyte globulin preparations, rabbit and horse anti-thymocyte globulin appear to have a similar efficacy for up-front treatment of severe aplastic anemia. Clinicaltrial.gov: NCT01231841).

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Figures

Figure 1.
Figure 1.
Survival by number of poor prognostic features present. At 5 years, patients with more than two poor prognostic features (i.e. higher age, lower ANC and ALC) had a 16%+10% survival rate compared to 71%+9%% for patients with two or fewer poor prognostic features (P<0.001).
See this image and copyright information in PMC

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