Abstract
Immunosuppression has recently been proposed for low-risk myelodysplastic syndromes (MDS) to reverse bone marrow failure by inhibiting intramedullary secretion of proapoptotic cytokines. We treated 35 MDS patients (24 refractory anaemia (RA), 10 RA with excess blasts and one chronic myelomonocytic leukaemia) with either horse antithymocyte globulin 15 mg/kg/day or rabbit antithymocyte globulin 3.75 mg/kg/day, each for 5 days. Median age was 63 years (range: 41–75). After 1 to 34+ months of follow-up (mean: 15+), four patients experienced complete haematological responses (CR), six good responses (GR) and two minor responses. All CRs and GRs occurred in patients with RA, in whom both horse and rabbit ATG yielded five responses out of 12 (42%). Time to response varied between 1 and 10 (mean: 3) months. The median duration of response was 9+ (1–17+) months; five patients are in continuing response. In all, 23 patients suffered side effects >°II WHO (the degree of toxicity encountered according to the internationally accepted WHO toxicity grading); one patient died 2 weeks after rabbit ATG from rhinocerebral mucormycosis. Parameters that correlated with response were duration of disease and RA subgroup. In our experience, immune-modulating therapy with either horse or rabbit ATG is feasible in patients with RA and short duration of disease.
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Acknowledgements
We are grateful to Professor Hartmut Hecker, Department of Biometry, Hannover Medical School, for his invaluable help with the statistical analyses, to Dietmar Klose, Department of Hematology and Oncology, Hannover Medical School, for graphical assistance and to Michael Morgan, Department of Hematology and Oncology, Hannover Medical School, for critical reading of the manuscript. This work was supported in part by Imtix SangStat GmbH, Leimen, Germany, to AG.
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Stadler, M., Germing, U., Kliche, KO. et al. A prospective, randomised, phase II study of horse antithymocyte globulin vs rabbit antithymocyte globulin as immune-modulating therapy in patients with low-risk myelodysplastic syndromes. Leukemia 18, 460–465 (2004). https://doi.org/10.1038/sj.leu.2403239
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DOI: https://doi.org/10.1038/sj.leu.2403239
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