The Use of Anti-Human T Lymphocyte Porcine Immunoglobulin and Cyclosporine A to Treat Patients with Acquired Severe Aplastic Anemia

Abstract

Objective: To evaluate the treatment efficacy and tolerance of anti-human T lymphocyte porcine immunoglobulin (p-ALG) plus cyclosporine A (CsA) in acquired severe aplastic anemia (SAA). Method: Forty-eight SAA patients [31 males and 17 females; 17 with very SAA (VSAA)] were treated with p-ALG plus CsA and were analyzed retrospectively according to early mortality, response rate and quality, survival rate, toxicity, and complications. They were stratified further by gender, age, disease severity, interval from diagnosis to treatment, and preexisting infections. Result: The median age was 28 years (range 13–64). The interval from diagnosis to treatment was 45 days. The median neutrophil count was 0.178 × 10⁹/l. The overall response was 83.3% (54.2% complete and 29.2% partial) with a 90-day median time (range 23–380), and 10.4% died of infection within 30 days. The 1.5-year survival was 87.5%. vSAA patients had less response, a higher early mortality, and less survival (64.7, 29.4, 51.8%) compared to SAA patients (93.5, 0, and 100%, respectively; p < 0.05). Groups with different age, gender, intervals between diagnosis and treatment, and preexisting infections had the same response. Mild toxicities were observed. Conclusion: p-ALG plus CsA is a reliable and well-tolerated treatment for SAA, and it has the great advantage of a much lower cost compared to horse/rabbit ATG. VSAA was a poor predictive factor for the response rate.

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

“…Most previous studies have focused on hATG and rATG; however, studies comparing pALG and rATG, which are widely used in China, are lacking. We retrospectively analyzed the efficacies, survival, and safety profiles in patients that were treated with pALG and rATG, and found that the 1-yr overall response rate was 83.78% in the pALG group and the median time to first response was 94 (17-265) d, which are in agreement with the findings of Bing et al (16) and Zhang et al (19). The 5-yr overall survival rate of the patients was 82.22% and the event-free survival rate was 71.11% in the pALG group in the present study, while for the rATG group, our results showed that the 1-yr overall response rate was 66.67%, the median time to first response was 146 (31-334) d, and the 5-yr overall survival rate and event-free survival rate were both 68.75%, which were in accordance with the findings of the EBMT (20), the National Institutes of Health (NIH) (21), the Cleveland Clinic study (22), and Zheng et al (2006) (23).…”

“…We retrospectively analyzed the efficacies, survival, and safety profiles in patients that were treated with pALG and rATG, and found that the 1‐yr overall response rate was 83.78% in the pALG group and the median time to first response was 94 (17–265) d, which are in agreement with the findings of Bing et al . and Zhang et al . .…”

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

“…Utilizing the large AA population in our hospital, for the first time, we analyzed pATG in combination with CsA for efficacy, survival, side effects, and risk factors influencing efficacy. During the median 59.6-month follow-up period, the overall response rate was 74.5%, slightly lower than the 83.3% we previously reported (6). The difference may be due to the larger sample and longer follow-up time of the current study.…”

Antibodies in the Treatment of Aplastic Anemia

“…Various ATG preparations exist, which differ in both the stimulating antigens (peripheral lymphocytes, thymocytes or even T-cell lines), and/or the host animal (horse, rabbit or pig) (Bing et al 2010;Passweg and Tichelli 2009;Risitano et al 2010) (Table 2). In the last two decades, physicians have employed several commercially available ATG preparations without distinction.…”

“…Based on these results at the moment ATG-Fresenius cannot be considered a standard IST for patients with AA. Porcine ATG has also been employed successfully in the treatment of SAA in China (Bing et al 2010), but comparative studies with hATG are not available; it has been claimed that porcine ATG is substantially cheaper than both equine and leporine.…”