title: Predictors of response to immunosuppressive therapy with antithymocyte globulin and cyclosporine and prognostic factors for survival in patients with severe aplastic anemia.
abstract: BACKGROUND
  Immunosuppressive therapy (IST) with antithymocyte globulin (ATG) plus cyclosporine (CSA) is standard therapy in patients with severe aplastic anemia (SAA) who do not have an available HLA-matched sibling donor.
  
  
  METHODS
  The current study aimed to determine the predictive factors for response to IST in patients with SAA and to identify prognostic factors following IST. A total of 62 patients diagnosed with SAA who received IST with either rabbit ATG (n = 33) or horse ATG (n = 29) plus CSA between October 1994 and December 2007 were included.
  
  
  RESULTS
  With a median follow-up duration of 60.5 months, complete response and overall response were estimated to be 31% and 53%, respectively. The 4 yr overall survival rate was 75 + or - 6%. In terms of predicting the response to IST, neutrophil counts above 0.3 x 10(9)/L prior to IST were the only significant predictive factor (P = 0.02). Survival following IST was significantly different in favor of both the group showing high absolute reticulocyte counts (ARC) above 10.9 x 10(9)/L prior to IST (P = 0.004) and the group achieving any response following IST (P = 0.002).
  
  
  CONCLUSIONS
  Pre-IST neutrophil counts might predict the response to IST, while absolute ARCs prior to IST and response status after IST could be prognostic factors following IST.
authors.affiliation: Department of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Myung H
authors.initials: MH
authors.lastname: Chang
authors.forename: Kyoung H
authors.initials: KH
authors.lastname: Kim
authors.forename: Hyo S
authors.initials: HS
authors.lastname: Kim
authors.forename: Hyun J
authors.initials: HJ
authors.lastname: Jun
authors.forename: Dong H
authors.initials: DH
authors.lastname: Kim
authors.forename: Jun H
authors.initials: JH
authors.lastname: Jang
authors.forename: Kihyun
authors.initials: K
authors.lastname: Kim
authors.forename: Chul W
authors.initials: CW
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D000818:Animals; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005260:Female; D006736:Horses; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011817:Rabbits; D017701:Reticulocyte Count; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine