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Comparison between horse and rabbit antithymocyte globulin as first-line treatment for patients with severe aplastic anemia: a single-center retrospective study

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Abstract

The best antithymocyte globulin preparation for first-line immune suppression in patients with severe aplastic anemia is still not clear. The aim of this study was to compare hematological response and overall survival in patients submitted to horse or rabbit antithymocyte globulin as first-line treatment for severe aplastic anemia. We retrospectively compared 71 consecutive patients with severe aplastic anemia, classified according to the antithymocyte globulin preparation. Analyses included variables related to patients and to immune suppression. Forty two patients (59.1%) received horse and 29 (40.9%) rabbit antithymocyte globulin. Response rates were higher at 6 months in patients submitted to horse in comparison to rabbit antithymocyte globulin (59.5% versus 34.5% respectively, p = 0.05). Median time to response was similar between the two groups (99 versus 88.5 days, respectively, for horse and rabbit antithymocyte globulin; p = 0.98). Overall survival at 2 years was significantly higher in patients submitted to horse in comparison to rabbit antithymocyte globulin (78.4% versus 55.4%, p = 0.03). Post-treatment response was strongly associated with survival at 2 years (97% in responders versus 41.2% in non-responders, p < 0.001). Use of rabbit antithymocyte globulin was an independent predictor of death (odds ratio 2.5; 95% confidence interval 1.03–6.04; p = 0.04). Rabbit antithymocyte globulin was associated with a significant and prolonged lymphopenia in comparison with horse antithymocyte globulin. Our data suggest the superiority of horse over rabbit antithymocyte globulin as first-line treatment for severe aplastic anemia, both regarding hematological response and survival.

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The authors reported no potential conflicts of interest.

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Authors and Affiliations

  1. Hematopoietic Stem Cell Program, Hemorio, Rua Frei Caneca, 8, Rio de Janeiro, RJ, 20.211-030, Brazil

    Elias Hallack Atta, Danielle Saldanha Peixoto Dias & Vera Lúcia Neves Marra

  2. Instituto Nacional de Câncer, CEMO, Praça Cruz Vermelha, 23, Rio de Janeiro, RJ, 20.230-130, Brazil

    Elias Hallack Atta & Alexandre Mello de Azevedo

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  1. Elias Hallack Atta
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  2. Danielle Saldanha Peixoto Dias
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  3. Vera Lúcia Neves Marra
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  4. Alexandre Mello de Azevedo
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Correspondence to Elias Hallack Atta.

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Author contributions

EHA: conception and design of the study, analysis and interpretation of data, drafting the manuscript; DSDP: conception and design of the study, analysis and interpretation of data; VLNM: analysis and interpretation of data, drafting the manuscript; AMA: analysis and interpretation of data, drafting the manuscript. All authors approved the final version submitted for publication.

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Atta, E.H., Dias, D.S.P., Marra, V.L.N. et al. Comparison between horse and rabbit antithymocyte globulin as first-line treatment for patients with severe aplastic anemia: a single-center retrospective study. Ann Hematol 89, 851–859 (2010). https://doi.org/10.1007/s00277-010-0944-y

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  • DOI: https://doi.org/10.1007/s00277-010-0944-y

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