Antithymocyte globulin and cyclosporine for treatment of 44 children with hepatitis associated aplastic anemia

Osugi, Yuko; Yagasaki, Hiroshi; Shinoda, Masahiro; Kosaka, Yoshiyuki; Taga, Takashi; Ito, Toshiharu; Yamamoto, Masuji; Ohara, Akira; Sato, Tadatsugu; Mimaya, J; Tsukimoto, Ichiro; Kojima, Seiji

doi:10.3324/haematol.11359

Cited by 54 publications

(72 citation statements)

References 17 publications

(16 reference statements)

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“…OS (58 versus 54 %, P = 0.6) at 11 years between the two arms was similar because most patients who failed to respond to IST received salvage treatments including repeated IST. Subsequent trials validated horse ATG/CsA as standard IST regimen by showing satisfactory results with a 60-80 % probability of response and 60-90 % OS (Table 1) [28][29][30].…”

Section: Immune-mediated Pathophysiology Of Aplastic Anemiamentioning

confidence: 99%

The optimal immunosuppressive therapy for aplastic anemia

Shin

Lee

2013

Int J Hematol

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Immunosuppressive treatment (IST) has been the most effective therapeutic modality for patients with aplastic anemia (AA) who are not eligible for allogeneic stem cell transplantation from HLA-matched siblings because of donor unavailability, old age, or comorbidities. The combination of horse anti-thymocyte globulin (ATG) with cyclosporine A (CsA) has shown satisfactory results for these patients, and so it has been regarded as the standard IST regimen. However, treatment failure including unresponsiveness, relapse, and occurrence of clonal evolution remains a major problem, although the results of IST have been improved in the past two decades. Many studies have been conducted to overcome these problems; however, they have yet to show any satisfactory results. This review will discuss immune-mediated pathophysiology of AA, which is associated with therapeutic targets of immunosuppressive agents and clinical outcomes of most commonly used IST regimens. Several trials to improve IST including the addition of other immunosuppressive agents or growth factors to standard IST regimen, comparison between horse ATG/CsA and rabbit ATG/CsA as first-line treatment, and promising alternative agents including alemtuzumab and eltrombopag will also be discussed, focusing on recently published literatures.

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Section: Immune-mediated Pathophysiology Of Aplastic Anemiamentioning

confidence: 99%

The optimal immunosuppressive therapy for aplastic anemia

Shin

Lee

2013

Int J Hematol

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“…A population-based, case-control study in Thailand also revealed that the proportion of patients attributable to exposure to drugs was only 5%, which resulted in the conclusion that use of drugs did not explain the relatively high incidence of AA in Thailand [7]. Also, although East Asia is a hepatitis prevalent area, incidence of hepatitis-associated AA in Asia is not so high compared to in Europe [8,9]. One possibility is high incidence of cryptic type of inherited bone marrow failure syndromes including Fanconi anemia and dyskeratosis congenita (DC) in Asian population.…”

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confidence: 99%

Why is the incidence of aplastic anemia higher in Asia?

Kojima

2017

Expert Review of Hematology

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“…Recently, the prognosis has been clarified after the administration of antithymocyte globulin (ATG) and cyclosporine in patients with HAA (4). The overall response rate was regarded as 70.4% after 6 months, and curiously, of 33 patients showing a response to immunosuppressive treatment, recurrence was not observed (4). In the literature, only one patient showed recurrence one year after treatment and one month after the discontinuation of cyclosporine (1).…”

Section: Introductionmentioning

confidence: 99%

“…It has been demonstrated that immunosuppressive treatment is effective (1,3). Recently, the prognosis has been clarified after the administration of antithymocyte globulin (ATG) and cyclosporine in patients with HAA (4). The overall response rate was regarded as 70.4% after 6 months, and curiously, of 33 patients showing a response to immunosuppressive treatment, recurrence was not observed (4).…”

Section: Introductionmentioning

confidence: 99%