A 13-year-old boy was admitted to a local hospital because of pancytopenia. A bone marrow aspiration and biopsy revealed severely hypocellular marrow with no obvious leukemic cells. The diagnosis was severe aplastic anemia, and the patient was treated with antithymocyte globulin and cyclosporin A. A trilineage response was obtained, and the patient became transfusion-independent within 2 weeks. Two months later, the peripheral blood count normalized with an increased bone marrow cellularity. However, the patient was readmitted 5 months later for recurrence of the pancytopenia. A bone marrow aspiration revealed hypocellular marrow with morphologically blastoid cells. A surface marker study revealed the presence of a single clone that was positive for CD7, CD33, CD34, and HLA-DR. A diagnosis of hypoplastic leukemia was made on the basis of morphology and the surface marker studies. Retrospectively, the laboratory findings were the same as those seen at the onset of the disease. The patient did not respond to combination chemotherapy consisting of vincristine, prednisolone, cyclophosphamide, L-asparaginase, and doxorubicin, but administration of etoposide resulted in complete remission. An in vitro study revealed that >95% of the leukemic cells of this patient could be lysed after an incubation with antithymocyte globulin and human AB serum or baby rabbit serum. These findings suggest the efficacy of antithymocyte globulin in treating certain hypoplastic leukemias.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Camitta B, O’Reilly RJ, Sensenbrenner L, et al. Antithoracic duct lymphocyte globulin therapy of severe aplastic anemia.Blood. 1983;62:883–888.
Champlin R, Ho W, Gale RP. Antithymocyte globulin treatment in patients with aplastic anemia: a prospective randomized trial.N Engl J Med. 1983;308:113–118.
Bonnefoy-Berard N, Revillard JP. Mechanisms of immunosuppression induced by antithymocyte globulins and OKT3.J Heart Lung Transplant. 1996;15:435–442.
Genestier L, Fournel S, Flacher M, et al. Induction of Fas (Apo-1, CD95)-mediated apoptosis of activated lymphocytes by polyclonal antithymocyte globulins.Blood. 1998;91:2360–2368.
Raefsky EL, Gascon P, Gratwohl A, Speck B, Young NS. Biological and immunological characterization of ATG and ALG.Blood. 1986;68:712–719.
Bonnefoy-Berard N, Vincent C, Revillard JP. Antibodies against functional leukocyte surface molecules in polyclonal antilymphocyte and antithymocyte globulins.Transplantation. 1991;51:669–6733.
Tsuge I, Kojima S. Comparison of antibody specificities of four anti-thymocyte/anti-lymphocyte globulin products.Curr Ther Res. 1995;56:671–677.
Fisher RI, Silver BA, Vanhaelen CP, Jaffe ES, Cossman J. Objective regressions of T-and B-cell lymphomas in patients following treatment with anti-thymocyte globulin.Cancer Res. 1982;42:2465–2469.
Kojima S, Hibi S, Kosaka Y, et al. Immunosuppressive therapy using antithymocyte globulin, cyclosporine, and danazol with or without human granulocyte colony-stimulating factor in children with acquired aplastic anemia.Blood. 2000;96:2049–2054.
Greco B, Bielory L, Stephany D, et al. Antithymocyte globulin reacts with many normal human cell types.Blood. 1983;62:1047–10544.
Bonnefoy-Berard N, Genestier L, Flacher M, et al. Apoptosis induced by polyclonal antilymphocyte globulins in human B-cell lines.Blood. 1994;83:1051–1059.
Baum W, Steininger H, Bair HJ, et al. Therapy with CD7 monoclonal antibody TH-69 is highly effective for xenografted human T-cell acute lymphoblastic leukemia.Br J Haematol. 1996;95:327–3388.
Drenou B, Blancheteau V, Burgess DH, Fauchet R, Charron DJ, Mooney NA. A caspase-independent pathway of MHC class II antigen-mediated apoptosis of human B lymphocytes.J Immunol. 1999;163:4115–4124.
Vidovic D, Toral JI. Selective apoptosis of neoplastic cells by the HLA-DR-specific monoclonal antibody.Cancer Lett. 1998;128:127–1355.
Leveille C, Zekki H, Al-Daccak R, Mourad W. CD40- and HLADR- mediated cell death pathways share a lot of similarities but differ in their use of ADP-ribosyltransferase activities.Int Immunol. 1999;11:719–730.
Killick SB, Marsh JCW, Gordon-Smith EC, Sorlin L, Gibson FM. Effects of antithymocyte globulin on bone marrow CD34+ cells in aplastic anemia and myelodysplasia.Br J Haematol. 2000;108:582–5922.
Faille A, Barrett AJ, Balitrand N, Ketels F, Gluckman E, Najean Y. Effect of antilymphocyte globulin on granulocyte precursors in aplastic anaemia.Br J Haematol. 1979;42:371–380.
Mangan KF, D’Alessandro L, Mullaney MT. Action of antithymocyte globulin on normal human erythroid progenitor cell proliferation in vitro: erythropoietic growth-enhancing factors are released from marrow accessory cells.J Lab Clin Med. 1986;107:353–3644.
Hunter RF, Mold NG, Mitchell RB, Huang AT. Differentiation of normal marrow and HL60 cells induced by antithymocyte globulin.Proc Natl Acad Sci U S A. 1985;82:4823–4827.
Gascon P, Zoumbos NC, Scala G, Djeu JY, Moore JG, Young NS. Lymphokine abnormalities in aplastic anemia: implications for the mechanism of action of antithymocyte globulin.Blood. 1985;65:407–4133.
Kawano Y, Nissen C, Gratwohl A, Speck B. Immunostimulatory effects of different antilymphocyte globulin preparations: a possible clue to their clinical effect.Br J Haematol. 1988;68:115–119.
Hatta Y, Iwata T, Takeuchi J, Ohshima T, Horie T. Complete remission in a patient with hypoplastic acute lymphoblastic leukemia induced by granulocyte-colony-stimulating factor.Acta Haematol. 1995;94:39–43.
Yanagisawa K, Yano A, Takada K, Yasukawa M, Fujita S. Increase of erythropoiesis and thrombopoiesis, and induction of remission by granulocyte colony-stimulating factor (G-CSF) in a patient with hypoplastic leukemia [letter].Leukemia. 1994;8:1249–12511.
Maloney DG, Liles TM, Czerwinski DK, et al. Phase I clinical trial using escalating single-dose infusion of chimeric anti-CD20 monoclonal antibody (IDEC-C2B8) in patients with recurrent B-cell lymphoma.Blood. 1994;84:2457–2466.
McLaughlin P, Grillo-Lopez AJ, Link BK, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program.J Clin Oncol. 1998;16:2825–2833.
Hale G, Dyer MJ, Clark MR, et al. Remission induction in non- Hodgkin lymphoma with reshaped human monoclonal antibody CAMPATH-1H.Lancet. 1988;2:1394–1399.
About this article
Cite this article
Yoshimi, A., Nakamoto, C., Nakamura, Y. et al. Induction of Complete Remission of Hypoplastic Leukemia with Antithymocyte Globulin. Int J Hematol 77, 277–281 (2003). https://doi.org/10.1007/BF02983786
- Antithymocyte globulin
- Hypoplastic leukemia
- Complement-mediated cytolysis