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Efficacy of porcine antihuman lymphocyte immunoglobulin compared to rabbit antithymocyte immunoglobulin as a first-line treatment against acquired severe aplastic anemia

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Abstract

Immunosuppressive therapy (IST) with antithymocyte immunoglobulin (ATG) or antilymphocyte immunoglobulin (ALG) and cyclosporine A (CsA) is the treatment of choice against severe aplastic anemia (SAA) worldwide. However, a comparison of the efficacy of porcine ALG (pALG) and rabbit ATG (rATG) as a first-line treatment for acquired SAA has not been reported. In the present study, we retrospectively analyzed SAA patients treated with either pALG (n = 43) or rATG (n = 32) and compared their hematologic responses and survivals. There were no significant differences in overall response (OR) rates between pALG and rATG groups at 3 months (OR 41.86 versus 40.62 % (P = 0.914), 6 months (OR 66.67 versus 61.29 % (P = 0.635), 9 months (OR 69.05 versus 61.29 % (P = 0.490), or 12 months (OR 69.05 versus 64.51 % (P = 0.684), respectively. The OR rates in patients with SAA or very severe aplastic anemia (vSAA) in both groups were similar after a 12-month treatment (pALG 74.07 versus 60.00 %, P = 0.550; rATG 70.00 versus 54.55 %, P = 0.640). Patients who experienced <30-day interval between diagnosis and treatment displayed higher OR rates (at 12 months) than those with intervals ≥30 days (pALG 83.33 versus 50.00 %, P = 0.021; rATG 87.50 versus 40.00 %, P = 0.006). There were no significant differences in 2-year overall survival (OS) between pALG (87.4 ± 6.2 %) and rATG (83.2 ± 7.8 %) (P = 0.493). Infection was the major cause of death in both groups. In summary, pALG + CsA showed similar efficacy as rATG + CsA, as a first-line treatment for acquired SAA.

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Acknowledgments

This work was supported by the Network Hospital of Clinical Medicine Science and Technology Project, Jiangsu Science and Technology Department (No. BL2012005), Hematology Academician Workstation of Huai’an City (No. HAP201321), the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD), Jiangsu Province’s Key Medical Center (ZX201102), National Clinical Key Specialty Development Project, and National Public Health Grand Research Foundation (No. 201202017).

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, Suzhou, Jiangsu Province, 215006, People’s Republic of China

    Limin Liu, Xiaoli Li & Depei Wu

  2. Department of Hematology, Huai’an Hospital Affiliated to Xuzhou Medical College and Huai’an Second People’s Hospital, 62 Huaihai South Road, Huai’an, Jiangsu Province, 223002, People’s Republic of China

    Limin Liu, Xingxia Zhang & Yanming Zhang

  3. The People’s Hospital of Yinzhou, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, Zhejiang Province, 315040, People’s Republic of China

    Li Ding

  4. The People’s Hospital of Peixian, Peixian, Jiangsu Province, 221600, People’s Republic of China

    Lin Hao

  5. The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, 730000, People’s Republic of China

    Liansheng Zhang & Zhengdong Hao

  6. Haikou People’s Hospital, Haikou, Hainan Province, 570208, People’s Republic of China

    Meiqing Lei

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  1. Limin Liu
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  2. Li Ding
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  3. Lin Hao
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  7. Zhengdong Hao
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  8. Meiqing Lei
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  9. Yanming Zhang
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  10. Depei Wu
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Corresponding authors

Correspondence to Yanming Zhang or Depei Wu.

Additional information

Limin Liu, Li Ding, and Lin Hao contributed equally to this paper. They are co-first authors.

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Liu, L., Ding, L., Hao, L. et al. Efficacy of porcine antihuman lymphocyte immunoglobulin compared to rabbit antithymocyte immunoglobulin as a first-line treatment against acquired severe aplastic anemia. Ann Hematol 94, 729–737 (2015). https://doi.org/10.1007/s00277-014-2279-6

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  • DOI: https://doi.org/10.1007/s00277-014-2279-6

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