Comparison of porcine anti‐human lymphocyte globulin and rabbit anti‐human thymocyte globulin in the treatment of severe aplastic anemia: a retrospective single‐center study

Ma, Xiaoli; Wang, Jin; Zhang, Wanggang; Cao, Xing‐Mei; Chen, Yinxia; He, Aili; Liu, Jie; Yang, Nan; Wang, JianLi; Yang, Yun; Yang, Xu

doi:10.1111/ejh.12584

Cited by 16 publications

(8 citation statements)

References 27 publications

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“…Liu et al [ 21 ] retrospectively analyzed SAA patients treated with either P-ALG (n = 43) or R-ATG (n = 32) plus CSA, and suggested there were no significant difference in 2-year OS between the 2 groups (87.4% ± 6.2% vs 83.2% ± 7.8%, P = 0.493). Other studies [ 10 , 11 ] comparing the efficacy of P-ALG and R-ATG in the IST treatment showed similar results.…”

Section: Discussionsupporting

confidence: 52%

“…However, horse ATG is not available in China, while a new porcine anti-lymphocyte globulin (P-ALG) is available. Several studies have compared the efficacy and safety of R-ATG and P-ALG in IST and suggested that P-ALG was similar to or even better than R-ATG [ 9 – 11 ]. In addition, P-ALG containing conditioning regime before HSCT in the setting of MSD-HSCT and MUD-HSCT have also demonstrated good efficacy and tolerance [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of porcine ALG and rabbit ATG on outcomes of HLA-haploidentical hematopoietic stem cell transplantation for patients with acquired aplastic anemia

et al. 2022

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Objective To evaluate the efficacy and safety of P-ALG (porcine anti-lymphocyte globulin) and R-ATG (rabbit anti-thymocyte globulin) in the conditioning regime for patients with acquired aplastic anemia who underwent HLA-haploidentical hematopoietic stem cell transplantation (halpo-HSCT). Methods A total of 91 patients with acquired aplastic anemia who received haplo-HSCT at our center between January 2014 and December 2020 were retrospectively reviewed. Twenty-eight patients were in the P-ALG group while sixty-three patients were in the R-ATG group. Results The median time was 11 versus 13 days (P = 0.294) for myeloid engraftment and 12.5 versus 15 days (P = 0.465) for platelet engraftment in the P-ALG and R-ATG groups, respectively. There were no significant difference in 5-year overall survival (74.83% ± 8.24% vs 72.29% ± 6.26%, P = 0.830), GVHD-free, failure-free survival (71.05% ± 8.65% vs 62.71% ± 6.22%, P = 0.662), failure-free survival (74.83% ± 8.24% vs 66.09% ± 5.84%, P = 0.647) and transplantation-related mortality (25.17% ± 8.24% vs 26.29% ± 6.22%, P = 0.708) between the two groups. The incidence of aGVHD (acute graft versus host disease) (65.39% ± 9.33% vs 62.71% ± 6.30%, P = 0.653), II–IV aGVHD (38.46% ± 9.54% vs 35.64% ± 6.24%, P = 0.695), III–IV aGVHD (19.23% ± 7.73% vs 10.53% ± 4.07%, P = 0.291), cGVHD (chronic graft versus host disease) (22.22% ± 12.25% vs 22.31% ± 6.30%, P = 0.915), and moderate to severe cGVHD (5.56% ± 5.40% vs 9.28% ± 4.46%, P = 0.993) were not significantly different. Similar outcomes were observed between the P-ALG and R-ATG groups for severe bacterial infection (17.9% vs 25.4%, P = 0.431), invasive fungal diseases (3.6% vs 9.5%, P = 0.577) and graft rejection (0% vs 9.5%, P = 0.218). However, the incidence of cytomegalovirus infection and Epstein-Barr virus infection was significantly lower in the P-ALG group (46.4% vs 71.4%, P = 0.022; 3.6% vs 25.4%, P = 0.014). Conclusion The efficacy and safety of P-ALG were similar with R-ATG in the setting of haplo-HSCT for patients with acquired aplastic anemia patients. P-ALG could be an alternative for R-ATG.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Comparison of porcine ALG and rabbit ATG on outcomes of HLA-haploidentical hematopoietic stem cell transplantation for patients with acquired aplastic anemia

et al. 2022

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“…Zhang et al [34] demonstrated that the half-life of R-ATG was 29.7 ± 2.60 days and the effective serum concentration of R-ATG was maintained for at least 90 days in vivo. Ma et al [35] compared the safety and efficacy of P-ATG with R-ATG in SAA and found the lymphocyte count decreased in both groups, whereas the R-ATG group had a longer time of lymphocyte decrease and lower lymphocyte counts. They then further compared the changes in subsets of T cell until 6 months after the treatment and found the inhibitory effects on the CD8 + T cells were not significantly different between the 2 groups, whereas the inhibitory effects on CD4 + T cells were significantly stronger in the R-ATG group than in the P-ATG group.…”

Section: Discussionmentioning

confidence: 99%

Effect of Antithymocyte Globulin Source on Outcomes of HLA-Matched Sibling Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Severe Aplastic Anemia

Chen

Wei

Huang

et al. 2018

Biology of Blood and Marrow Transplantation

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We wanted to evaluate efficacy of porcine antithymocyte globulin (ATG) in HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation (MSD-HSCT) for patients with severe aplastic anemia (SAA). The clinical data of 113 SAA patients who received MSD-HSCT from January 2005 to November 2016 were analyzed retrospectively. Of these, 58 patients received rabbit ATG as a part of conditioning regimen (R-ATG group), whereas the other 55 patients received porcine ATG (P-ATG group). Patient baseline characteristics and donor conditions of the 2 groups were similar, except patients were older and more received peripheral blood stem cell transplantation in the P-ATG group. All patients engrafted in 2 groups. There were significant differences in the incidence of acute (20.7% ± 5.3% versus 43.4% ± 7.0%, P = .015) and chronic graft-versus- host disease (GVHD; 20.1% ± 5.8% versus 46.0% ± 7.9%, P = .003) between the R-ATG and P-ATG groups. However, there were no significant differences in terms of 3-year overall survival (93.1% ± 3.3% versus 84.4% ± 5.7%, P = .235), grades III to IV acute GVHD (3.4% ± 2.4% versus 12.3% ± 4.7%, P = .098), moderate to severe chronic GVHD (12.6% ± 4.9% versus 11.5% ± 4.9%, P = .905), or graft rejection (7.4% ± 3.6% versus 5.5% ± 3.1%, P = .852). There was also no significant difference with regard to the incidence of severe bacterial infection (P = .075), invasive fungal disease (P = .701), or cytomeglovirus viremia (P = .770). P-ATG showed satisfactory efficacy and safety compared with R-ATG in the setting of MSD-HSCT for SAA patients. P-ATG could be a potential alternative preparation for R-ATG, further offering the advantage of lower costs.

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“…While Chinese patients only have access to rabbit and porcine ATG. The porcine form is more widely used and promoted due to its good efficacy, safety, and low price (34)(35)(36). Recent articles (36)(37)(38)(39) have reported that the overall response and survival rates of AA patients using standard IST with porcine ATG plus CsA are neither better nor worse than those with rabbit ATG.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of early death risk score model for emergency status prediction in very severe aplastic anemia

et al. 2023

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This study developed and validated the Early Death Risk Score Model for early identification of emergency patients with very severe aplastic anemia (VSAA). All 377 patients with VSAA receiving first-line immunosuppressive therapy (IST) were categorized into training (n=252) and validation (n=125) cohorts. In the training cohort, age >24 years, absolute neutrophil count ≤0.015×109/L, serum ferritin >900ng/mL and times of fever before IST >1 time were significantly associated with early death. Covariates were assigned scores and categorized as: low (score 0-4), medium (score 5-7) and high (score ≥8) risk. Early death rate was significantly different between risk groups and the validation cohort results were consistent with those of the training cohort. The area under the receiver operating characteristic curve for the model was 0.835 (0.734,0.936) in the training cohort and 0.862 (0.730,0.994) in the validation cohort. The calibration plots showed high agreement, and decision curve analysis showed good benefit in clinical applications. The VSAA Early Death Risk Score Model can help with early identification of emergency VSAA and optimize treatment strategies. Emergency VSAA with high risk is associated with high early death rate, and alternative donor hematopoietic stem cell transplantation could be a better treatment than IST even without HLA-matching.

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Comparison of porcine anti‐human lymphocyte globulin and rabbit anti‐human thymocyte globulin in the treatment of severe aplastic anemia: a retrospective single‐center study

Abstract: The efficacies, survival, and safety profiles of pALG-based treatments are similar to or even better than those of rATG-based treatments. These results may help guide the clinical use of pALG in immunosuppressive therapy for SAA.

Cited by 16 publications

References 27 publications

Comparison of porcine ALG and rabbit ATG on outcomes of HLA-haploidentical hematopoietic stem cell transplantation for patients with acquired aplastic anemia

Comparison of porcine ALG and rabbit ATG on outcomes of HLA-haploidentical hematopoietic stem cell transplantation for patients with acquired aplastic anemia

Effect of Antithymocyte Globulin Source on Outcomes of HLA-Matched Sibling Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Severe Aplastic Anemia

Development and validation of early death risk score model for emergency status prediction in very severe aplastic anemia

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