title: Early intensified intravenous cyclosporine therapy predicts favorable response to immunosuppressive therapy with rabbit antithymocyte globulin in patients with severe aplastic anemia.
abstract: Because of relapse after horse ATG (hATG) therapy, rabbit ATG (rATG) would be a realistic alternative as second line immunosuppressive therapy (IST) in severe aplastic anemia (SAA) patients. We investigated whether intensified intravenous (IV) CsA therapy with rATG would increase the response of IST in SAA patients. Sixty-one of the 123 patients received IV CsA therapy with rATG during initial 2 weeks then changed to oral form (IV CsA group), while other 62 patients just received oral CsA therapy with rATG (oral CsA group). Hematologic response rates at 3 and 6 months were not different between IV CsA group and oral CsA group (p=0.795, p=0.079). However, CsA levels during initial 15 days were higher in response-achieved group than response-not-achieved group. Intensive IV CsA group maintained CsA level ≥ 300 ng/ml during 15 days had higher responses at 6 months than non-intensive IV CsA group and oral CsA group (p=0.009, p=0.021). Intensive IV CsA group (HR=3.239, 95% CI=1.095-8.997, p=0.013) independently predicted favorable the hematologic response at 6 months of IST. Early intensified CsA therapy was important to achieve favorable outcomes in IST including rATG.
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Republic of Korea.
authors.forename: Moo-Kon
authors.initials: MK
authors.lastname: Song
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Republic of Korea. Electronic address: Hemon@pusan.ac.kr.
authors.forename: Joo-Seop
authors.initials: JS
authors.lastname: Chung
authors.affiliation: Department of Hematology, Busan Haeundae Paik Hospital, Busan, Republic of Korea.
authors.forename: Young-Don
authors.initials: YD
authors.lastname: Joo
authors.affiliation: Department of Hematology, Gyeong-Sang National University Hospital, school of medicine, Gyeong-Sang National University, Jinju, Republic of Korea.
authors.forename: Gyeong-Won
authors.initials: GW
authors.lastname: Lee
authors.affiliation: Department of Hematology, Gachon University Gil Medical Center, Incheon, Republic of Korea.
authors.forename: Junshik
authors.initials: J
authors.lastname: Hong
authors.affiliation: Department of Laboratory Medicine, Pusan National University Hospital, Republic of Korea.
authors.forename: Sang-Hyuk
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Republic of Korea.
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Shin
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000188:drug therapy* / Q000401:mortality; D000818:Animals; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D016572:Cyclosporine / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011817:Rabbits; D012008:Recurrence; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D004338:Drug Combinations; D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: Antithymocyte globulin; Aplastic anemia; Cyclosporine