Rabbit antithymocyte globulin versus horse antithymocyte globulin for treatment of acquired aplastic anemia: a retrospective analysis
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Studies comparing rabbit antithymocyte globulin (rATG) and horse ATG (hATG) in patients with aplastic anemia (AA) have shown conflicting results. These studies included fewer than 60 subjects in the rATG arm with relatively short follow-up. A total of 169 patients treated with rATG and 62 treated with hATG were included in this retrospective analysis, across 33 centers. Patients were treated with rATG or hATG plus cyclosporine A. Over half were classified, as having severe AA (SAA) or very severe AA (VSAA), and the mean follow-up was 45 months. There was no significant difference detected in cumulative response to treatment or survival between the rATG and hATG groups. The response to treatment was 63 % in the rATG group versus 66 % in the hATG group at 3 months. By 12 months, this pattern had reversed, and 84 % of rATG patients had responded to treatment versus 76 % in the hATG group (n.s.). Early mortality due to infection tended to be higher with rATG compared to hATG (n.s). rATG and hATG would seem to be therapeutically equivalent in SAA and VSAA. However, patients treated with rATG may take longer to respond than those treated with hATG and may also require more active prevention of early infections.
KeywordsAplastic anemia Antibody therapy Clinical aspects Immunotherapy Late effects of therapy
The authors would like to thank the following centers that contributed cases for analysis: S. Brunet (H. U. Sant Pau, Barcelona), L. Yáñez (H. U. Valdecilla, Santander), Á. Bendaña (C. H. U. S. Compostela, Pontevedra), J. de la Serna (H. U. Doce de Octubre, Madrid), M. González (H. Niño Jesús, Madrid), E. Pérez (H. U. M. Meseguer, Murcia), A. Sampol (H. U. Son Dureta, P. Mallorca), C. García (H. G. Alicante), I. Espigado (H. U. V. Rocío, Sevilla), MJ. Requena (H. Severo Ochoa, Madrid), A. Cantalapiedra (H. U. Río Ortega, Valladolid), J. Petit (I. C. Oncología, Barcelona), R. Campo (H. Son Llatzer, P. Mallorca), M. Sanz (H. Río Carrión, Palencia), L. Vázquez (H. U. Salamanca), R. Arranz (H. U. La Princesa, Madrid), A. Bailén (H. U. Carlos Haya, Málaga), MC. Viguria (C. H. Navarra), J. Bergua (H. Cáceres), M. López (H. Alcalá de Henares, Madrid), P. García (H. U. La Paz Infantil, Madrid), Á. Dasi (H. U. La Fe Infantil, Valencia), C. Solano (H. Clínico de Valencia), J. Moraleda (H. U. V. Arrixaca, Murcia). The authors would also like to thank E. Mayor (H. U. Central de Asturias) for support with data management; E. Berlanas (RPS Research Iberica, Spain) for data monitoring and quality control. Denise Bumford, a freelance medical writer supported by funding from Sanofi Aventis Group, provided drafts and editorial assistance to the authors during preparation of this manuscript.
CV and the Bone Marrow Failure Spanish Study Group (Pethema-GETH) designed and performed the research and analyzed and interpreted the data. Denise Bumford a freelance medical writer supported by funding from Sanofi Aventis Group, developed a draft manuscript for author review. CV, PM(2), MP, BC, MM, AR, BX, JLD, OS, ÁC, PM(12,13) and CR critically reviewed the manuscript and approved the final version for journal submission.
Conflict of interest
CV and JLD have received speaker fees from Sanofi Aventis Group. PM(2), MP, BC, MM, AR, BX, OS, ÁC, PM(12,13), and CR report no conflicts of interest.
The services of the freelance medical writer were supported by a grant from Sanofi Aventis group.
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