Tichelli A, Passweg J, Nissen C, Bargetzi M, Hoffmann T, Wodnar-Filipowicz A, Signer E, Speck B, Gratwohl A
Department of Central Laboratory, University Hospitals, Basel, Switzerland.
Br J Haematol. 1998 Feb;100(2):393-400. doi: 10.1046/j.1365-2141.1998.00578.x.
In a single-centre study the feasibility and efficacy of repeated antilymphocyte globulin (ALG) for patients with severe aplastic anaemia (SAA) not responding to an initial ALG treatment or relapsing after initial response to ALG was evaluated. 139 consecutive patients with newly diagnosed SAA were treated with ALG between 1976 and 1995. 89 patients responded to a first course; 50 patients did not become transfusion independent. Of the 89 responders, 66 remained in remission, 23 relapsed. 43 patients received a second or subsequent course of ALG for failure to respond (n = 25) or relapse (n = 18) and were given a total of 53 courses. Acute reactions in the multiply exposed patients occurred during the first ALG treatment in 11 (26%) and during subsequent exposures in 16/53 courses (30%; P > 0.2). Incidence of serum sickness was 63% (27/43) after the initial course compared to 57% (30/53) after subsequent courses (P > 0.2), but clinical signs of serum sickness occurred earlier after repeated (median 6 d) as compared to initial exposure (13d; P = 0.008). Transfusion-independent haemopoiesis was achieved in 27/43 (63%) and survival probabilities for the 43 patients receiving multiple courses of ALG was 52 +/- 8% at 10 years. The probability of developing a late clonal disorder was 53 +/- 10% after multiple, as compared to 34 +/- 7% after single exposure (P = 0.15). No difference in results was observed between patients retreated for failure to first ALG or for relapse. ALG of the same species can be repeated without increased risks of side-effects in patients with SAA. A second or subsequent course of ALG from the same source can be effective when the first course has failed.
在一项单中心研究中，评估了重复使用抗淋巴细胞球蛋白（ALG）治疗对初始ALG治疗无反应或初始反应后复发的重型再生障碍性贫血（SAA）患者的可行性和疗效。1976年至1995年间，139例新诊断的SAA患者接受了ALG治疗。89例患者对第一疗程有反应；50例患者未实现不依赖输血。在89例有反应者中，66例仍处于缓解期，23例复发。43例患者因无反应（n = 25）或复发（n = 18）接受了第二疗程或后续疗程的ALG治疗，共接受了53个疗程。多次接受ALG治疗的患者中，11例（26%）在首次ALG治疗期间出现急性反应，16/53个疗程（30%）在后续治疗期间出现急性反应（P > 0.2）。初始疗程后血清病发生率为63%（27/43），后续疗程后为57%（30/53）（P > 0.2），但与首次暴露相比，重复暴露后血清病的临床症状出现得更早（中位时间6天对13天；P = 0.008）。27/43（63%）的患者实现了不依赖输血的造血，接受多个疗程ALG治疗的43例患者10年生存率为52±8%。多次暴露后发生晚期克隆性疾病的概率为53±10%，单次暴露后为34±7%（P = 0.15）。首次ALG治疗无反应或复发后再次治疗的患者之间未观察到结果差异。相同种类的ALG可在SAA患者中重复使用，且副作用风险不会增加。当第一疗程失败时，来自同一来源的第二疗程或后续疗程的ALG可能有效。
