Abstract
Immunosuppressive therapy is the treatment of choice in patients with severe aplastic anemia (SAA) not eligible for an allogeneic bone marrow transplant. We treated 10 patients with a combination of Tecelac (Biotest, Germany) (1.5 mg/kg/day for 4 days), Cyclosporine (5 mg/kg/day for 6 months) and Prednisolone (2mg/kg/day for 3 weeks and taper over 1 week). Tecelac is a rabbit anti-T cell immunoglobulin produced by Biotest Germany from rabbits immunized with human peripheral blood lymphocytes. Antibiotic and blood product support was given as required. Ten patients (8 males; 2 females) with a median age of 26 years (range: 18–40) were treated. The median time from diagnosis to treatment was 2 months (range: 1 – 4). The median absolute lymphocyte count (ALC) pre ATG was 1537/cumm (range: 1224 – 1748) while the median ALC post ATG was 40/cumm (range: 20 – 200). None of the patients developed serum sickness. Two patients expired due to bacterial infection (Staphylococcal sepsis and Escherichia Coli sepsis) on day +14 and day +40 post ATG. Response was seen in 5(62.5%) out of 8 evaluable patients. Two patients achieved complete normalization of blood counts. Two patients have become transfusion independent for 6 – 12 months of which one had a relapse after 12 months. One patient showed improvement in the absolute neutrophil count (ANC) and platelet count with a decrease in transfusion frequency. Three patients (37.5%) showed no improvement in blood counts and continue to remain transfusion dependant. At a median follow up of 22 months (16 – 30), the overall survival is 80% with a disease free survival of 37%. Rabbit ATG induces remission in a small number of patients with severe aplastic anemia and the results are comparable with some reports using equine ATG/ALG. Larger studies need to be done to evaluate the efficacy of rabbit ATG in severe aplastic anemia.
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