Porcine antilymphocyte globulin (p-ALG) plus cyclosporine A (CsA) treatment in acquired severe aplastic anemia: a retrospective multicenter analysis

Wei, Jia; Huang, Zhiping; Guo, Jing-Ming; Zhang, Youshan; Wang, Chunyan; Zhu, Xianmin; Zhang, Yicheng

doi:10.1007/s00277-015-2308-0

Cited by 27 publications

(20 citation statements)

References 34 publications

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“…Some studies [33,36] indicated that P-ATG showed similar efficacy and safety profiles to R-ATG in immunosuppressive therapy of acquired SAA. P-ATG could be a suitable alternative preparation for R-ATG with the advantage of lower medical expense.…”

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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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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“…It is 40% cheaper than r-ATG and has been widely used as an IST agent for AA in China. 10,11 Despite its extensive use, no studies have compared the efficacy and safety of p-ALG vs r-ATG combined with CSA as a first-line IST for children with AA. In this retrospective study, we analyzed the response rates, adverse events and toxicity, and long-term survival of 189 pediatric patients with AA treated with p-ALG or r-ATG plus CSA.…”

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confidence: 99%

Efficacy and safety of porcine ALG compared to rabbit ATG as first‐line treatment for children with acquired aplastic anemia

Zhu

Yang

et al. 2020

European J of Haematology

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Objective To assess the outcomes of children with acquired aplastic anemia (AA) treated in China with first‐line porcine anti‐lymphocyte immunoglobulin (p‐ALG)/rabbit anti‐thymocyte immunoglobulin (r‐ATG) combined with cyclosporine A (CSA). Methods We performed a single‐center, non‐randomized, retrospective cohort study to assess the outcomes of 189 children with AA treated in China with first‐line p‐ALG/r‐ATG combined with CSA between 2014 and 2018. Results No significant differences were observed in the overall response rates at 3, 6, 12, or 24 months (3 months: 61.9% vs 67.4%, P = .5; 6 months: 70.9% vs 73.9%, P = .69; 12 months: 77.3% vs 73.3%, P = .58; 24 months: 81.6% vs 78.6%, P = .59) after either p‐ALG‐ or r‐ATG‐based immunosuppressive therapy. No significant differences were observed in overall survival or failure‐free survival between the p‐ALG group and the r‐ATG group. Conclusion Our results reveal that the therapeutic efficacy and safety of p‐ALG combined with CSA did not differ significantly from those of r‐ATG combined with CSA as first‐line therapy for pediatric patients with AA. Moreover, p‐ALG has the advantage of significantly lower cost compared with r‐ATG.

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“…In a prospective study, the cumulative recurrence rate at 3 years follow-up was 28% for horse ATG and 11% for rabbit ATG (no significant difference) (16). We notice that in other reports of porcine ATG, the relapse rates were also very low at 1.4-2.1% (6,17). However, as 73.5% of the patients we analyzed were younger than 40 years old, we think that this may also contribute to the low relapse rate and good response rate.…”

Section: Discussionmentioning

confidence: 70%

Long‐term follow‐up study of porcine anti‐human thymocyte immunoglobulin therapy combined with cyclosporine for severe aplastic anemia

Chen

Liu

Zhuang

et al. 2015

European J of Haematology

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Immunosuppressive therapy with antithymocyte immunoglobulin (ATG) and cyclosporine A is the first treatment option for severe aplastic anemia (SAA) patients without transplantation. Horse ATG is not marketed in China. Because the price of porcine ATG (pATG) is only about one-third of the price of rabbit ATG (rATG), long-term follow-up studies of pATG's efficacy will help provide valuable insights into the treatment of SAA. Retrospective studies were performed to analyze the clinical information of 102 SAA patients treated with pATG and cyclosporine A from 1999 to 2014 in Peking Union Medical College Hospital. The median age was 29 years old (range 12-72). Median follow-up time was 59.6 months (0.2-176.8). The overall response rate was 74.5% (CR 42.1%, PR 32.4%). The recurrence rate was 9.9%. The mortality rate was 16.7%. The median survival time has not been reached, and the 5-year survival rate was 81.8%. Other hematologic abnormalities were observed in 7.8% of patients, including symptomatic PNH, MDS, and AML. Multivariate analysis revealed there was no significant effect on survival by factors such as gender, age, severity of disease, treatment time, and PNH clone (P > 0.05). These data have indicated pATG therapy combined with cyclosporine A has significant long-term efficacy and high overall survival in SAA.

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Porcine antilymphocyte globulin (p-ALG) plus cyclosporine A (CsA) treatment in acquired severe aplastic anemia: a retrospective multicenter analysis

Cited by 27 publications

References 34 publications

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

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

Efficacy and safety of porcine ALG compared to rabbit ATG as first‐line treatment for children with acquired aplastic anemia

Long‐term follow‐up study of porcine anti‐human thymocyte immunoglobulin therapy combined with cyclosporine for severe aplastic anemia

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