Anti Thymocyte Globulin-Based Treatment for Acquired Bone Marrow Failure in Adults

Abstract

Idiopathic acquired aplastic anemia can be successfully treated with Anti Thymocyte Globulin (ATG)-based immune suppressive therapy and is therefore considered a T cell-mediated auto immune disease. Based on this finding, several other forms of idiopathic acquired bone marrow failure are treated with ATG as well. For this review, we extensively searched the present literature for evidence that ATG can lead to enduring remissions in different forms of acquired multi- or single-lineage bone marrow failure. We conclude that ATG-based therapy can lead to an enduring hematopoietic response and increased overall survival (OS) in patients with acquired aplastic aplasia. In patients with hypocellular myelodysplastic syndrome, ATG can lead to a hematological improvement without changing the OS. ATG seems less effective in acquired single-lineage failure diseases like Pure Red Cell Aplasia, Amegakaryocytic Thrombocytopenia and Pure White Cell Aplasia, suggesting a different pathogenesis in these bone marrow failure states compared to aplastic anemia. T cell depletion is hypothesized to play an important role in the beneficial effect of ATG but, as ATG is a mixture of polyclonal antibodies binding to different antigens, other anti-inflammatory or immunomodulatory effects could play a role as well.

Increased IFN‐γ+ and TNF‐α+ mucosal‐associated invariant T cells in patients with aplastic anemia

“…Aplastic anemia (AA) is a rare and serious disease characterized by peripheral blood (PB) pancytopenia and hypocellular bone marrow (Peffault de Latour et al, 2022). AA is considered an autoimmune disease caused by an aberrant T cell immune response (Tjon et al, 2021).…”

“…Aplastic anemia (AA) is a rare and serious disease characterized by peripheral blood (PB) pancytopenia and hypocellular bone marrow (Peffault de Latour et al, 2022). AA is considered an autoimmune disease caused by an aberrant T cell immune response (Tjon et al, 2021). Most studies on T cell immune pathogenesis in AA have focused on conventional T cells that recognize antigen peptides presented by polymorphic major histocompatibility complex (MHC) molecules (Li et al, 2016; Shallis et al, 2018; Zhao et al, 2019).…”

The long-term outcome and safety of severe aplastic anemia treated with porcine antilymphocyte globulin plus cyclosporine, with or without thrombopoietin receptor agonists: a double-center retrospective study

“…Antilymphocyte globulin is a potent immunosuppressant, it can be divided into rabbit-derived ATG(r-ATG),horse-derived ATG(h-ATG), and porcine-derived ATG(p-ATG) according to the source of animals [6].Horse-derived ATG 6-month hematology response rate between 60-75%.Rabbit-derived ATG treatment is inferior to h-ATG [7,8], it is usually used to people who have received h-ATG but have no response or relapse [9,10]. However, Since 2000, h-ATG has not been available in China, therefore r-ATG is the only option for IST.…”

The Effect of Low Doses of Zearalenone (ZEN) on the Bone Marrow Microenvironment and Haematological Parameters of Blood Plasma in Pre-Pubertal Gilts

“…Each day, red marrow produces 200 billion new morphotic elements in the blood. It is composed of delicate, highly vascular, fibrous tissue, and it contains hematopoietic stem cells, which give rise to various types of blood cells that are transported to the bloodstream upon maturation [26]. Yu and Scadden [27] described bone marrow as a carrier with sub-compartments that support different haematopoietic activities.…”