ATG plus cyclosporine reduces all-cause mortality in patients with severe aplastic anemia--systematic review and meta-analysis.
BACKGROUND
Immunosuppression is the therapeutic alternative for patients with aplastic anemia who are ineligible for allogeneic transplant. We aimed to assess the benefit of the combination of antithymocyte globulin (ATG) and cyclosporine (CsA).


METHODS
We performed a systematic review and meta-analysis of all randomized controlled trials that compared ATG and CsA to ATG alone as first-line treatment for patients with severe and nonsevere aplastic anemia. The Cochrane Library, Medline, conference proceedings and references were searched until 2008. Relative risks (RR) with 95% confidence intervals (CIs) were estimated for each trial and pooled.


RESULTS
Our search yielded 4 trials. For patients with severe aplastic anemia, there was a significant reduction in mortality in the ATG and CsA arm, which began at 3 months (RR = 0.50, 95% CI 0.29-0.85) and was maintained over a long follow-up of 5 years (RR = 0.58, 95 % CI 0.36-0.93). Conversely, in patients with nonsevere aplastic anemia, there was no difference in mortality.


CONCLUSIONS
The combination of both drugs should be considered the gold standard only for patients with severe aplastic anemia.
Gafter-Gvili
Anat
A
Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel. anatga2@clalit.org.il
Ram
Ron
R
Gurion
Ronit
R
Paul
Mical
M
Yeshurun
Moshe
M
Raanani
Pia
P
Shpilberg
Ofer
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000741:Anemia, Aplastic / Q000188:drug therapy*; D000961:Antilymphocyte Serum / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016572:Cyclosporine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D016572:Cyclosporine