Comparable outcomes with low‑dose and standard‑dose horse anti‑thymocyte globulin in the treatment of severe aplastic anemia
10.1007/s44313-024-00003-z
- Author:
Arihant JAIN
1
;
Aditya JANDIAL
;
Thenmozhi MANI
;
Kamal KISHORE
;
Charanpreet SINGH
;
Deepesh LAD
;
Gaurav PRAKASH
;
Alka KHADWAL
;
Reena DAS
;
Neelam VARMA
;
Subhash VARMA
;
Pankaj MALHOTRA
Author Information
1. Department of Clinical Hematology and Medical Oncology, PGIMER, Chandigarh 160012, India
- Publication Type:RESEARCH
- From:Blood Research
2024;59():6-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background:The standard dose (SD) of horse anti-thymocyte globulin (hATG) ATGAM (Pfizer, USA) or its biosimilar thymogam (Bharat Serum, India) for the treatment of Aplastic Anemia (AA) is 40 mg/kg/day for 4 days in combination with cyclosporine. Data on the impact of hATG dose on long-term outcomes are limited. Here, we describe our comparative experience using 25 mg/kg/day (low-dose [LD]) hATG for 4 days with SD for the treatment of AA.
Methods:We retrospectively studied patients with AA (age > 12 years) who received two doses of hATG combined with cyclosporine. Among 93 AA patients who received hATG, 62 (66.7%) and 31 (33.3%) patients received LD and SD hATG with cyclosporine, respectively. Among these,seventeen(18.2%) patients also received eltrombopag with hATG and cyclosporine. Overall response rates [complete response (CR) and partial response (PR)] of LD and SD hATG groups at 3 months (50% vs. 48.4%; p = 0.88), 6 months (63.8% vs. 71.4%; p = 0.67), and 12 months (69.6% vs.79.2%; p = 0.167) were comparable. The mean (Standard Deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival was 82.1 (4.6)% and 70.9 (5.5)% for the study population. The mean (standard deviation) 5-year Kaplan–Meier estimate of overall survival and event-free survival of those who received LD hATG versus SD hATG dose was 82.9 (5·3)% versus 74.8 (10·3)% (p = 0·439), and 75.2 (6.2)% versus 61.4(11.2)% (p = 0·441).
Conclusion:Our study revealed that the response rates of patients with AA and LD were similar to those of patients with SD to hATG combined with cyclosporine in a real-world setting.
