First-line immunosuppressive therapy with rATG and CsA for severe aplastic anemia: 15 years’ experience

Hu, Jing; Zhang, Li; Zhao, Xin; Liu, Xu; Jing, Liping; Zhou, Kang; Li, Yuan; Li, Yang; Li, Jianping; Ye, Lei; Peng, Guangxin; Fan, Huihui; Yang, Wenrui; Yang, Yang; Xiong, Yuanyuan; Song, Lin; Zhang, Feng-Kui

doi:10.1007/s00277-022-04952-2

Cited by 6 publications

(6 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 17 – 19 , 31 The comparison of the outcomes of different preparations of ATG is listed in Table 3 . 11 – 18 , 29 , 30 , 32 – 38 Hence, although h-ATG is not available in China, the early efficacy of p-ATG is comparable to that of r-ATG or h-ATG, and the early death rate is low.…”

Section: Discussionmentioning

confidence: 99%

“…[17][18][19]31 The comparison of the outcomes of different preparations of ATG is listed in Table 3. [11][12][13][14][15][16][17][18]29,30,[32][33][34][35][36][37][38] Hence, although h-ATG is not available in China, the early efficacy of p-ATG is comparable to that of r-ATG or h-ATG, and the early death rate is low. In our large cohort with long-term follow-up, the 5-year OS was 83.7%, which was a favorable result and comparable to that of a recent EBMT study.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Antihuman T lymphocyte porcine immunoglobulin combined with cyclosporine as first-line immunosuppressive therapy for severe aplastic anemia in China: a large single-center, 10-year retrospective study

Yang

Liu

Zhao

et al. 2023

Therapeutic Advances in Hematology

Self Cite

View full text Add to dashboard Cite

Background: Antihuman T lymphocyte porcine immunoglobulin (p-ATG) has been the most common ATG preparation in immunosuppressive therapy (IST) in Chinese patients with severe aplastic anemia (SAA) since 2009. Objectives: This study aimed to evaluate the early hematologic response and long-term outcomes of a large cohort of patients with SAA who received p-ATG plus cyclosporine (CsA) as first-line therapy from 2010 to 2019. Design: This is a single-center retrospective study of medical records. Methods: We analyzed the data of 1023 consecutive patients with acquired aplastic anemia (AA) who underwent p-ATG combined with CsA as a first-line IST treatment from 2010 to 2019 at our department. Results: The median age of the patients was 24 (4–75) years, and the median follow-up time was 57.2 months (3 days–137.5 months). There was an early mortality rate of 2.8% with a median death time of 0.9 months (3 days–2.9 months). The overall response rates were 40.6% and 56.1% at 3 and 6 months, respectively. The 5-year cumulative incidences of relapse and clonal evolution were 9.0% [95% confidence interval (CI) = 4.2–16.0%] and 4.5% (95% CI = 1.4–10.6%), respectively. The 5-year overall survival (OS) and event-free survival rates were 83.7% (95% CI = 81.1–86.0%) and 50.4% (95% CI = 47.1–53.5%), respectively. Conclusion: p-ATG combined with CsA for the treatment of AA is effective and safe, and p-ATG can be used as an alternative ATG preparation for the standard IST regimen in areas in which h-ATG is not available.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antihuman T lymphocyte porcine immunoglobulin combined with cyclosporine as first-line immunosuppressive therapy for severe aplastic anemia in China: a large single-center, 10-year retrospective study

Yang

Liu

Zhao

et al. 2023

Therapeutic Advances in Hematology

Self Cite

View full text Add to dashboard Cite

show abstract

“…A previous study reported that rATG was inferior to horse ATG (hATG) for the treatment of aplastic anemia (28). However, in recent investigations rATG achieved comparable overall response rate and survival to that of hATG whereas the latter is not available in China (29)(30)(31). Moreover, we previously showed that porcine ATG represented as an alternative ATG preparation for standard IST regimen (32).…”

Section: Discussionmentioning

confidence: 96%

Comparison of hematopoietic stem cell transplantation and immunosuppressive therapy as the first-line treatment option for patients with severe hepatitis−associated aplastic anemia

Zhang

Yang

et al. 2023

Front. Immunol.

Self Cite

View full text Add to dashboard Cite

Hepatitis-associated aplastic anemia (HAAA) is a rare variant of acquired aplastic anemia characterized with a syndrome of bone marrow failure after hepatitis. We retrospectively analyzed the outcomes of consecutive severe HAAA patients who received immunosuppressive therapy (IST, n = 70), matched-sibling donor hematopoietic stem cell transplantation (MSD-HSCT, n = 26) or haploidentical-donor (HID) HSCT (n = 11) as the first-line treatment. In the IST group, the hematologic response (HR) rate was 55.71% at 6 months. In contrast, HSCT recipients exhibited significantly more rapid and sustained hematopoiesis (HR 76.92%, 96.15% and 96.15% at 3, 6 and 12months, respectively). The 5-year overall survival (OS) was not different among IST (83.7 ± 4.9%), MSD-HSCT (93.3 ± 6.4%) and HID-HSCT group (80.8 ± 12.3%). Compared with IST, MSD and HID-HSCT demonstrated a trend of superiority in the estimated 5-year failure-free survival rates (93.3 ± 6.4% vs 64.3 ± 6.0%, p = 0.05; 80.8 ± 12.3% vs 64.3 ± 6.0%, p = 0.57). In subsequent stratified analysis on age, we found that HID-HSCT showed its efficacy and safety among young patients. In sum, MSD-HSCT remains first-line treatment choice for HAAA, whereas HID-HSCT represents an alternative treatment choice in addition to IST for young patients (< 40 years) without a matched sibling donor.

show abstract

“…A Chinese study ( 12 ) also found that SAA and VSAA patients who underwent HSCT versus those who did not have comparable 6-year OS rates at 75.5% and 76.3%, respectively. Hu et al ( 13 ) found that patients with AA undergoing first-line IST had an early-death rate of 7.6%, with 86% of the early death occurring in those with VSAA. In our study, early death occurred in 6.9% of VSAA patients treated with IST, with infection being the leading cause (65.4%, 17/26; 9/17 had two or more multisite complicated infections).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, this study found that age >35 years old and ANC ≤0.1×10 9 /L were independent risk factors for early death and suggested the need for new treatment strategies. Similarly, a study from China ( 13 ) included 542 patients with AA undergoing first-line IST (43.5% of which was VSAA) and showed that age >35 years old and insufficient granulocyte reserve were risk factors for early death. These findings are similar to our results.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of early death risk score model for emergency status prediction in very severe aplastic anemia

et al. 2023

Self Cite

View full text Add to dashboard Cite

This study developed and validated the Early Death Risk Score Model for early identification of emergency patients with very severe aplastic anemia (VSAA). All 377 patients with VSAA receiving first-line immunosuppressive therapy (IST) were categorized into training (n=252) and validation (n=125) cohorts. In the training cohort, age >24 years, absolute neutrophil count ≤0.015×109/L, serum ferritin >900ng/mL and times of fever before IST >1 time were significantly associated with early death. Covariates were assigned scores and categorized as: low (score 0-4), medium (score 5-7) and high (score ≥8) risk. Early death rate was significantly different between risk groups and the validation cohort results were consistent with those of the training cohort. The area under the receiver operating characteristic curve for the model was 0.835 (0.734,0.936) in the training cohort and 0.862 (0.730,0.994) in the validation cohort. The calibration plots showed high agreement, and decision curve analysis showed good benefit in clinical applications. The VSAA Early Death Risk Score Model can help with early identification of emergency VSAA and optimize treatment strategies. Emergency VSAA with high risk is associated with high early death rate, and alternative donor hematopoietic stem cell transplantation could be a better treatment than IST even without HLA-matching.

show abstract

First-line immunosuppressive therapy with rATG and CsA for severe aplastic anemia: 15 years’ experience

Cited by 6 publications

References 31 publications

Antihuman T lymphocyte porcine immunoglobulin combined with cyclosporine as first-line immunosuppressive therapy for severe aplastic anemia in China: a large single-center, 10-year retrospective study

Antihuman T lymphocyte porcine immunoglobulin combined with cyclosporine as first-line immunosuppressive therapy for severe aplastic anemia in China: a large single-center, 10-year retrospective study

Comparison of hematopoietic stem cell transplantation and immunosuppressive therapy as the first-line treatment option for patients with severe hepatitis−associated aplastic anemia

Development and validation of early death risk score model for emergency status prediction in very severe aplastic anemia

Contact Info

Product

Resources

About