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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP-
dc.contributor.authorCLE, Diego V.-
dc.contributor.authorATTA, Elias H.-
dc.contributor.authorDIAS, Danielle S. P.-
dc.contributor.authorLIMA, Carlos B. L.-
dc.contributor.authorBONDUEL, Mariana-
dc.contributor.authorSCIUCCATI, Gabriela-
dc.contributor.authorMEDEIROS, Larissa A.-
dc.contributor.authorOLIVEIRA, Michel M. de-
dc.contributor.authorFONSECA, Patricia B. Blum-
dc.contributor.authorSAAD, Sara T. O.-
dc.contributor.authorHAMERSCHLAK, Nelson-
dc.contributor.authorSALVINO, Marco A.-
dc.contributor.authorGARANITO, Marlene P.-
dc.contributor.authorPAZIN-FILHO, Antonio-
dc.contributor.authorSCHEINBERG, Phillip-
dc.contributor.authorCALADO, Rodrigo T.-
dc.identifier.citationANNALS OF HEMATOLOGY, v.97, n.11, p.2039-2046, 2018-
dc.description.abstractIn a prospective randomized study, treatment for aplastic anemia (AA) with rabbit antithymocyte globulin (r-ATG) and cyclosporine showed inferior hematological response and survival in comparison to horse antithymocyte globulin (h-ATG) and cyclosporine. However, h-ATG was discontinued in most Asian, South American, and European countries, where r-ATG became the only ATG formulation available. We retrospectively evaluated consecutive patients with acquired AA who received either rabbit (n=170) or horse (n=85) ATG and cyclosporine for first-line treatment from 1992 to 2014 in seven referral centers in Brazil and Argentina. Overall response at 3months was 17% (95%CI, 11-23%) for r-ATG and 44% (95%CI, 33-55%) for h-ATG (p<0.001). At 6months, it was 31% (95%CI, 34-39%) for r-ATG and 59% (95%CI, 48-69%) for h-ATG (p<0.001). Overall survival at 5years was 57% (95%CI, 47-65%) for r-ATG and 80% (95%CI, 69-87%) for h-ATG (log-rank=0.001). Relapse was significantly higher in patients receiving h-ATG (28%; 95%CI, 17-43%) as compared to r-ATG (9.4%; 95%CI, 4-21%; log-rank, p=0.01). The type of ATG was the only factor associated with both response and survival. The r-ATG dose varied from 1 to 5mg/kg/day, but it did not correlate with outcomes. In summary, this is the largest multicenter study comparing the two ATG formulations in AA. Our results indicate that the dose of r-ATG does not influence hematologic response or survival in first-line therapy for acquired AA. Considering the toxicity and costs of r-ATG, our findings challenge its aggregate benefit to cyclosporine therapy and further strengthen that h-ATG should remain standard therapy in AA.-
dc.relation.ispartofAnnals of Hematology-
dc.subjectAplastic anemia-
dc.subjectAntithymocyte globulin-
dc.subjectATG dose-
dc.subject.otheranti-thymocyte globulin-
dc.subject.otherhematopoietic progenitor cells-
dc.subject.otherregulatory t-cells-
dc.subject.otherimmunosuppressive therapy-
dc.titleRabbit antithymocyte globulin dose does not affect response or survival as first-line therapy for acquired aplastic anemia: a multicenter retrospective study-
dc.rights.holderCopyright SPRINGER-
dc.type.categoryoriginal article-
dc.type.versionpublishedVersion-, Diego V.:Univ Sao Paulo, Ribeirao Preto Sch Med, Dept Internal Med, Ribeirao Preto, SP, Brazil-, Elias H.:Brazilian Natl Canc Inst, CEMO, Rio De Janeiro, RJ, Brazil; Hemorio, Haematopoiet Stem Cell Program, Rio De Janeiro, RJ, Brazil-, Danielle S. P.:Brazilian Natl Canc Inst, CEMO, Rio De Janeiro, RJ, Brazil-, Carlos B. L.:Brazilian Natl Canc Inst, CEMO, Rio De Janeiro, RJ, Brazil-, Mariana:Hosp Pediat Prof Dr Juan P Garrahan, Serv Hematol Oncol, Buenos Aires, DF, Argentina-, Gabriela:Hosp Pediat Prof Dr Juan P Garrahan, Serv Hematol Oncol, Buenos Aires, DF, Argentina-, Larissa A.:Univ Fed Parana, Bone Marrow Transplantat Unit, Curitiba, PR, Brazil-, Michel M. de:Univ Fed Parana, Bone Marrow Transplantat Unit, Curitiba, PR, Brazil-, Patricia B. Blum:Darcy Vargas Childrens Hosp, Sao Paulo, Brazil-, Sara T. O.:Univ Estadual Campinas, Hemoctr, Hematol & Transfus Med Ctr, Campinas, SP, Brazil-, Nelson:Hosp Israelita Albert Einstein, Sao Paulo, SP, Brazil-, Marco A.:Univ Fed Bahia, Bone Marrow Transplantat Unit, Salvador, BA, Brazil-, Antonio:Univ Sao Paulo, Ribeirao Preto Sch Med, Dept Internal Med, Ribeirao Preto, SP, Brazil-, Rodrigo T.:Univ Sao Paulo, Ribeirao Preto Sch Med, Dept Internal Med, Ribeirao Preto, SP, Brazil-
hcfmusp.publisher.cityNEW YORK-
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