title: ATG plus cyclosporine reduces all-cause mortality in patients with severe aplastic anemia--systematic review and meta-analysis.
abstract: 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.
authors.affiliation: Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel. anatga2@clalit.org.il
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
authors.forename: Ronit
authors.initials: R
authors.lastname: Gurion
authors.forename: Mical
authors.initials: M
authors.lastname: Paul
authors.forename: Moshe
authors.initials: M
authors.lastname: Yeshurun
authors.forename: Pia
authors.initials: P
authors.lastname: Raanani
authors.forename: Ofer
authors.initials: O
authors.lastname: Shpilberg
mesh_terms: 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
chemical_list: D000961:Antilymphocyte Serum; D016572:Cyclosporine