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Relationship between plasma rabbit anti‐thymocyte globulin concentration and immunosuppressive therapy response in patients with severe aplastic anemia
Author(s) -
Narita Atsushi,
Muramatsu Hideki,
Ichikawa Daisuke,
Hamada Motoharu,
Nishikawa Eri,
Suzuki Kyogo,
Kawashima Nozomu,
Okuno Yusuke,
Nishio Nobuhiro,
Hama Asahito,
Yamazaki Hirohito,
Nakao Shinji,
Kojima Seiji,
Takahashi Yoshiyuki
Publication year - 2021
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13644
Subject(s) - anti thymocyte globulin , medicine , gastroenterology , confidence interval , odds ratio , aplastic anemia , globulin , anemia , complete response , immunology , chemotherapy , bone marrow
Objectives Patients with acquired aplastic anemia (AA) without HLA‐matched sibling donors or aged >40 years receive immunosuppressive therapy (IST) with anti‐thymocyte globulin (ATG). We investigated the relationship between plasma rabbit ATG (r‐ATG) concentration and IST response. Methods From May 2012 to October 2017, 81 patients with severe AA who required initial IST were included. A 1:1 block randomization was employed for 2.5 and 3.5 mg/kg doses of r‐ATG. Results No significant difference in response rates was observed between the 2.5 and 3.5 mg/kg groups (63% vs. 58%, P = .894). Median r‐ATG concentrations on days 14 and 28 after IST were 15.2 (0.0‐97.7) and 1.8 (0.0‐74.9 µg/mL), respectively. According to r‐ATG concentration, response rates were significantly higher in the group with higher r‐ATG concentration than in those with lower r‐ATG concentration (day 14, 88% vs. 52%; P = .006 and day 28, 79% vs. 46%; P = .005). In multivariate analysis, higher r‐ATG concentrations at day 28 were independent predictors of favorable response to IST at 6 months (odds ratio, 0.29; 95% confidence interval, 0.09‐0.93; P = .037). Conclusions The present data indicate that higher r‐ATG concentration at day 28 resulted in improved IST response.