Comparison Of Anti-human Lymphocyte/Thymocyte Immunoglobulin Therapy For Severe Aplastic Anemia In Different Species

Objective: To compare the efficacy and safety of anti-human lymphocyte globulin(ALG)/ anti-human thymocyte globulin(ATG)in the treatment of severe aplastic anemia(SAA)in different species.Methods: 71 patients diagnosed with severe aplastic anemia in the Department of Hematology of Wuhan Union Hospital,from January 2006 to June 2018 and received ALG/ATG combined with cyclosporine A(CsA)therapy were analysed retrospectively.The patients were divided into a pALG group(n = 37)and a rATG group(n = 34).The overall response rates(OR)of the patients at different stages,adverse reactions and overall survival were compared between groups respectively,and the factors influencing OR rates were analyzed.SPSS 20.0 software was used for the statistical analyses.The chi-squared test,Independent-Samples T test,or Mann–Whitney test was used for the comparisons between the pALG and rATG groups.Kaplan–Meier method was used to estimate the 5-yr survival,and log-rank test was used for the comparison between the two groups.Results: There were no significant differences in OR rates between pALG and rATG group at 3 months(OR 27.0% versus 17.6 %,P=0.345),6 months(OR 48.6%versus 41.2 %,P=0.527),or 12 months(OR 54.1% versus50%,P=0.733),respectively.The five-year OS was 78.4% for pALG-treated patients and 79.4% for rATG-treated patients(P = 0.794).And we found no significant differences between the OR rates and the age,sex,severity of the disease,ALG/ATG pre-treatment and co-infection in two groups.However,We found that the patients with the interval ≤30 days or SAA-I had significant higher OR rates than those with the interval >30 days or SAA-II in two groups.Within the half year after ALG/ATG treatment,the lymphocytes of the rATG group remained significantly lower than the pALG group,and the infection rate of rATG group was higher than that of pALG group,but thedifference was not statistically.The incidence of adverse responses was not significantly different between the pALG and rATG groups(P > 0.05).Infection was the main cause of death,with 73.3% of deaths related to it.Conclusions: 1.Porcine ALG is comparable with rabbit ATG in terms of therapeutic efficacy,survival or safety.2.SAA-I patients and patients whose interval between diagnosis and treatment was less than or equal to 30 days had better efficacy.3.Rabbit ATG has a stronger inhibitory effect on lymphocyte than Porcine ALG,but does not increase the infection rate significantly.