Efficacy of porcine antihuman lymphocyte immunoglobulin compared to rabbit antithymocyte immunoglobulin as a first-line treatment against acquired severe aplastic anemia

Abstract

Immunosuppressive therapy (IST) with antithymocyte immunoglobulin (ATG) or antilymphocyte immunoglobulin (ALG) and cyclosporine A (CsA) is the treatment of choice against severe aplastic anemia (SAA) worldwide. However, a comparison of the efficacy of porcine ALG (pALG) and rabbit ATG (rATG) as a first-line treatment for acquired SAA has not been reported. In the present study, we retrospectively analyzed SAA patients treated with either pALG (n = 43) or rATG (n = 32) and compared their hematologic responses and survivals. There were no significant differences in overall response (OR) rates between pALG and rATG groups at 3 months (OR 41.86 versus 40.62% (P = 0.914), 6 months (OR 66.67 versus 61.29% (P = 0.635), 9 months (OR 69.05 versus 61.29% (P = 0.490), or 12 months (OR 69.05 versus 64.51% (P = 0.684), respectively. The OR rates in patients with SAA or very severe aplastic anemia (vSAA) in both groups were similar after a 12-month treatment (pALG 74.07 versus 60.00%, P = 0.550; rATG 70.00 versus 54.55%, P = 0.640). Patients who experienced <30-day interval between diagnosis and treatment displayed higher OR rates (at 12 months) than those with intervals ≥30 days (pALG 83.33 versus 50.00%, P = 0.021; rATG 87.50 versus 40.00%, P = 0.006). There were no significant differences in 2-year overall survival (OS) between pALG (87.4 ± 6.2%) and rATG (83.2 ± 7.8%) (P = 0.493). Infection was the major cause of death in both groups. In summary, pALG + CsA showed similar efficacy as rATG + CsA, as a first-line treatment for acquired SAA.

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

“…In a study by Liu et al . , the 1‐yr response rate was 69.05% in the pALG group, which was not significantly different compared with the rATG group. In the present study, the 1‐yr response rate in the pALG group was substantially higher, which could be associated with the younger age, lower VSAA percentage, and longer time from diagnosis to treatment.…”

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

“…Porcine ALG is a product developed in China and was approved by the Sino Food and Drug Administration in 2004. A series of retrospective studies evaluating the efficacy of P-ALG in treatment of AA were conducted [ 8 – 13 , 21 – 24 ]. P-ALG was reported to have similar or superior overall response at 6 months compared to R-ATG (64.0–79.4% vs 48.1–64.7%) in the IST treatment for AA patients [ 25 ].…”

“…P-ALG was reported to have similar or superior overall response at 6 months compared to R-ATG (64.0–79.4% vs 48.1–64.7%) in the IST treatment for AA patients [ 25 ]. 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.…”

Inefficacy of Immunosuppressive Therapy for Severe Aplastic Anemia Progressing From Non-SAA: Improved Outcome After Allogeneic Hematopoietic Stem Cell Transplantation

“…All patients were treated in sterile rooms with strict reverse isolation from the beginning of therapy. The patients in the IST group were treated with rabbit ATG (rATG) 3.75 mg/kg/day or porcine antihuman lymphocyte immunoglobulin (pALG) 30 mg/kg/day from day 1 to day 5 ( 28 ). Oral CsA treatment (3–5 mg/kg/day) was started on the first day of rATG/pALG, and was administered for at least 2 years (with dose adjustments to achieve a whole-blood trough level of 200–250 ng/ml for adults and 150–200 ng/ml for children).…”