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Multicenter Study
. 2014 Apr;99(4):664-71.
doi: 10.3324/haematol.2013.089268. Epub 2013 Nov 8.

Long-term outcome after immunosuppressive therapy with horse or rabbit antithymocyte globulin and cyclosporine for severe aplastic anemia in children

Dae Chul Jeong  1 , Nack Gyun Chung, Bin Cho, Yao Zou, Min Ruan, Yoshiyuki Takahashi, Hideki Muramatsu, Akira Ohara, Yoshiyuki Kosaka, Wenyu Yang, Hack Ki Kim, Xiaofan Zhu, Seiji Kojima
Affiliations
Multicenter Study

Long-term outcome after immunosuppressive therapy with horse or rabbit antithymocyte globulin and cyclosporine for severe aplastic anemia in children

Dae Chul Jeong et al. Haematologica. 2014 Apr.

Abstract

Some prospective studies showed that rabbit antithymocyte globulin was inferior to horse antithymocyte globulin as first-line therapy for patients with severe aplastic anemia. We retrospectively analyzed the clinical outcome of 455 children with severe aplastic anemia who received horse antithymocyte globulin (n=297) or rabbit antithymocyte globulin (n=158) combined with cyclosporine as first-line therapy between 1992 and 2010. The response rates were comparable between the horse and rabbit antithymocyte globulin groups at 3 months [46% (136/294) versus 42% (66/153), P=0.55] and 6 months [60% (178/292) versus 55% (87/143), P=1.0]. Using multivariate analysis, differences in antithymocyte globulin preparations were not associated with response rates. However, 2-year and 10-year overall survival rates in the horse antithymocyte globulin group were significantly better than those in the rabbit antithymocyte globulin group (2-year overall survival: 96% versus 87%, 10-year overall survival: 92% versus 84%, P=0.004). On the basis of multivariate analysis, use of rabbit antithymocyte globulin was a significant adverse factor for overall survival (hazard ratio = 3.56, 95% confidence interval, 1.53 - 8.28, P=0.003). Rabbit antithymocyte globulin caused more profound immunosuppression, which might be responsible for the higher incidence of severe infections. Considering that there are no studies showing the superiority of rabbit antithymocyte globulin over horse antithymocyte globulin, horse antithymocyte globulin should be recommended as a first-line therapy. However, our results justify the use of rabbit antithymocyte globulin as first-line therapy if horse antithymocyte globulin is not available.

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Figures

Figure 1.
Figure 1.
(A) Overall survival for patients treated with rabbit ATG and cyclosporine compared to horse ATG and cyclosporine. (B) Transplant-free survival for patients treated with rabbit ATG and cyclosporine compared to horse ATG and cyclosporine. Transplantation is considered as an event.
Figure 2.
Figure 2.
(A) Cumulative incidence of clonal evolution in patients treated with rabbit ATG and cyclosporine compared to horse ATG and cyclosporine. (B) Cumulative incidence of relapse in patients treated with rabbit ATG and cyclosporine compared to horse ATG and cyclosporine.
See this image and copyright information in PMC

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References

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