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

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 infecti...

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Bibliographic Details
Published in:Annals of hematology 2017-11, Vol.96 (11), p.1907-1914
Main Authors: Atta, Elias H., Lima, Carlos B. L., Dias, Danielle S. P., Clé, Diego V., Bonduel, Mariana M., Sciuccati, Gabriela B., Medeiros, Larissa A., Oliveira, Michel M., Salvino, Marco A., Garanito, Marlene P., Blum Fonseca, Patricia B., Saad, Sara Teresinha O., Calado, Rodrigo T., Scheinberg, Phillip
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Anemia
Anemia, Aplastic - diagnosis
Anemia, Aplastic - drug therapy
Anemia, Aplastic - mortality
Animals
Antilymphocyte Serum - administration & dosage
Child
Child, Preschool
Female
Follow-Up Studies
Hematology
Humans
Immunosuppressive Agents - administration & dosage
Infant
Male
Medicine
Medicine & Public Health
Middle Aged
Mortality
Mortality - trends
Neutrophils
Oncology
Original Article
Predictive Value of Tests
Rabbits
Retrospective Studies
Severity of Illness Index
Treatment Outcome
Young Adult
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Summary: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 × 10 9 /L (OR 7.64, P   35 years (OR 1.88, P  = 0.03), baseline ANC ≤ 0.1 × 10 9 /L (OR 2.65, P  
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-017-3086-7