Int J Clin Exp Med 2015 Sep 15;8(9):16334-16339

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.

Eylem E1, Yahya B1, Ozlen B1, Umit M1, Gursel G1, Ayse I1, Haluk D1, Salih A1, Hakan G1, Nilgun S1, Ibrahim H1, Osman O1.
Immunosuppressive therapy (IST) with anti-T lymphocyte globulin (ATG) plus cyclosporine (CSA) is standard therapy in patients with non-severe aplastic anemia (AA) in need of treatment and severe aplastic anemia (SAA) who do not have an available HLA-matched donor. The aim of this study was to analyze patients submitted to different ATG preparations as first-line treatment.
l="BACKGROUND" NlmCategory="BACKGROUND">Immunosuppressive therapy (IST) with anti-T lymphocyte globulin (ATG) plus cyclosporine (CSA) is standard therapy in patients with non-severe aplastic anemia (AA) in need of treatment and severe aplastic anemia (SAA) who do not have an available HLA-matched donor. The aim of this study was to analyze patients submitted to different ATG preparations as first-line treatment.

PATIENTS AND METHODS:

We retrospectively analyzed adult aplastic anemia (AA) patients who received ATG as first-line treatment between 1999 and 2013 to compare hematologic response and survival.

RESULTS:

During the time period mentioned 4 different ATG preparations had been used in 38 AA patients (34 severe, 4 non-severe). Responses were better with Lymphoglobulin (6 complete response 1 partial response, 0 refractory disease and 2 death within 3 months after ATG, i.e. during induction), Thymoglobulin (3, 1, 4 and 1, respectively) or ATGAM (1, 2, 1 and 1) compared to the ATG-Fresenius (ATG-F) group (3, 0, 6 and 6) (P = .07). Statistically significant inferior results with ATG-Fresenius (3 complete or partial responses, 6 refractoriness and 6 induction deaths) were evident when other preparations are lumped together (14 complete or partial responses, 5 refractoriness and 4 induction mortalities) (P = .045). Estimated 1 year survival rates were 52.5% versus 76.9%, respectively (P = .13).

CONCLUSIONS:

These data support the notion that not all ATG preparations are suitable for use in AA.