Predictors of early mortality after rabbit antithymocyte globulin as first-line treatment in severe aplastic anemia | Aplastic Anemia and MDS International Foundation

Predictors of early mortality after rabbit antithymocyte globulin as first-line treatment in severe aplastic anemia

Journal Title: 
Ann Hematol
Primary Author: 
Atta EH
Author(s): 
Atta EH, Lima CBL, Dias DSP, Clé DV, Bonduel MM, Sciuccati GB, Medeiros LA, Oliveira MM, Salvino MA, Garanito MP, Blum Fonseca PB, Saad STO, Calado RT, Scheinberg P
Original Publication Date: 
Wednesday, August 16, 2017

Despite being recommended as first-line immunosuppressive therapy in severe aplastic anemia (SAA), horse antithymocyte globulin (ATG) is still unavailable in many countries outside the USA. Rabbit ATG is more lymphocytoxic than horse ATG, and this might result in a higher incidence of severe infections and early mortality. This study was designed to identify the risk factors for early mortality and overall survival (OS) after rabbit ATG in patients with SAA. We retrospectively reviewed 185 patients with SAA who underwent rabbit ATG and cyclosporine. The incidence of death in 3 months following rabbit ATG therapy was 15.1% (28/185). Early mortality was mainly related to infectious complications, despite adequate antibiotic and/or antifungal treatment. Age > 35 years (odds ratio [OR] 5.06, P = 0.001) and baseline absolute neutrophil count (ANC) ≤ 0.1 × 109/L (OR 7.64, P < 0.001) were independent risk factors for early mortality after immunosuppressive therapy with this agent. Hematological response at 6 months was observed in only 29.7% of all patients. OS at 1 year after rabbit ATG was 75.3%; and age > 35 years (OR 1.88, P = 0.03), baseline ANC ≤ 0.1 × 109/L (OR 2.65, P < 0.001), and lack of response to rabbit ATG (OR 11.40, P < 0.001) were independently associated with mortality. Alternative strategies are needed for the treatment of SAA patients in countries were horse ATG is unavailable, particularly for those at high risk for early mortality after rabbit ATG due to a higher age and very low pre-treatment neutrophil count.

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