Gupta Vikas, Gordon-Smith Edward C, Cook Gordon, Parker Anne, Duguid Jennifer K M, Wilson Keith M O, Yi Qi-Long, Marsh Judith C W
Division of Haematology, Department of Cellular and Molecular Sciences, St George's Hospital and Medical School, London, UK.
Br J Haematol. 2005 Apr;129(1):110-7. doi: 10.1111/j.1365-2141.2005.05406.x.
This retrospective study evaluated the outcome of 18 patients with aplastic anaemia treated with a third course of anti-thymocyte globulin (ATG)-containing immunosuppressive therapy (IST). Of the 18 patients, seven had responded to one of the previous courses of ATG and 11 were refractory to both the previous courses. Self-limiting grade >/=3 liver toxicity was observed in three patients. Two patients had to discontinue ATG because of severe systemic side effects. The incidence and manifestations of serum sickness did not appear to be different during the three courses. All of the seven patients that previously responded to one of the courses responded to a third course. In contrast, of 11 patients refractory to the previous courses, only two had a transient partial response. The 3-yr event-free survival for the patients who had responded to one of the previous courses of ATG was significantly superior to that of patients refractory to both the previous courses of ATG (83% vs. 0%, P = 0.0001). For aplastic anaemia patients, a third course of ATG-containing IST is a reasonable option in previous responders. Patients refractory to previous two courses of ATG have a much lower response rate and may be suitable candidates for novel therapeutic options.
这项回顾性研究评估了18例接受含抗胸腺细胞球蛋白（ATG）的第三疗程免疫抑制治疗（IST）的再生障碍性贫血患者的治疗结果。在这18例患者中，7例对之前的某一疗程ATG有反应，11例对之前的两个疗程均耐药。3例患者出现了自限性的≥3级肝毒性。2例患者因严重的全身副作用不得不停用ATG。血清病的发生率和表现似乎在三个疗程中并无差异。之前对某一疗程有反应的7例患者均对第三疗程有反应。相比之下，之前对两个疗程均耐药的11例患者中，只有2例有短暂的部分缓解。之前对某一疗程ATG有反应的患者的3年无事件生存率显著高于对之前两个疗程ATG均耐药的患者（83%对0%，P = 0.0001）。对于再生障碍性贫血患者，含ATG的第三疗程IST对之前有反应的患者是一个合理的选择。对之前两个疗程ATG耐药的患者缓解率低得多，可能是新型治疗方案的合适人选。
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