Aplastic anemia (AA) is an independent disease of bone marrow failure. Immunosuppressive agents are commonly used in the treatment of severe aplastic anemia, especially in the patients with severe aplastic anemia. ATG is an immunoglobulin obtained by immunizing horses, rabbits, pigs and other animals with human lymphocytes and isolating and purifying it from their blood. It can achieve the therapeutic purpose by consuming the lymphocytes in patients. So the question is, what is the effect of ATG? Does ATG work the same from different sources? Does ATG dose affect the outcome of treatment? Is the therapeutic effect of combination with etrap better? With these doubts, we review the literature together to explore the ATG treatment of aplastic anemia.
01
Is there any difference in the therapeutic effect of ATG from different sources?
The combination of ATG and CSA is recommended as a first-line immunosuppressive therapy for severe aplastic anemia / very severe aplastic anemia. In 1991, an article published by the German Re Group in New England medicine established the first-line treatment of severe aplastic anemia with ATG and cyclosporine, using equine ATG. In 1995, the young working group published an article that the therapeutic effect of rabbit ATG plus cyclosporine was very good. In 2011, the young working group randomly controlled the ATG from horse and rabbit sources, and believed that the effective rate of horse ATG was higher than that of rabbit ATG. It is worth noting that compared with the results reported in 1995, it is not that the therapeutic effect of horse derived ATG is improving, but that the therapeutic effect of rabbit derived ATG is even lower than that reported in 1995. As a big country with aplastic anemia, many data results show that the total effective rate of rabbit and pig ATG is more than 60%. So in the end, which is better or worse, let's review the follow-up literature.
02
The higher the dose of ATG, the better, or the lower the better?
In 2019, the prospective randomized controlled dose trial of 2.5mg and 3.5mg in apwg confirmed that there was no difference in efficacy, but the clinical control trial dropped more than 10% of cases, and the basic parameters of the two groups were inconsistent. All data analysis of 955 cases registered by group in Europe and Asia showed that the real-world dose and efficacy were related, and high dose could significantly improve the efficiency of patients. The study of Sun Yat Sen Memorial Hospital of Sun Yat sen University also found that the effective rate of high dose group was higher. So in the treatment of severe aplastic anemia, such a disease with abnormal immune mechanism, it should be treated with ATG in sufficient quantity and in full treatment, or with low dose of ATG?
03
ATG combined with etrapa, is the effect really amazing?
Etrapa, a TPO receptor agonist, has been approved by the FDA for the treatment of refractory SAA and has become a new choice for non transplant treatment of SAA. Young's working group found that the longer the time used, the more efficient it is to make etrap and ATG at the same time. However, MD Anderson carried out a prospective randomized controlled trial of etrapa and intensive immunotherapy in the same period, and found that there was no significant difference in the effective rate between the two groups. Is it necessary to use etrap? Let's take these questions with us and listen to the big guy's answers.
Answering questions and answering questions
A new trend of treatment of aplastic anemia
Professor He Guangsheng, Jiangsu People's Hospital and the First Affiliated Hospital of Nanjing Medical University, is invited to give an exclusive lecture in this show to interpret and analyze the literature of ATG treatment of aplastic anemia. If you want to know the clinical effect and prognosis of different ATG sources, if you are curious about the therapeutic effect of ATG treatment dose, if you still have doubts about the effect of etrap, come to join us and meet with Ding Xiangyuan's "the great show of handicap".
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Syllabus
One
Literature interpretation of different sources of ATG treatment differences
Two
Literature interpretation of the optimal therapeutic dose of rabbit ATG
Three
Literature interpretation of the therapeutic effect of etrap
He Guangsheng, chief physician
professor
professor
Chief physician, associate professor
Deputy director of Hematology administration, chief expert of hemopoietic failure, First Affiliated Hospital of Nanjing Medical University
Member of the international foundation for aplastic anemia myelodysplastic syndrome
Member of the International Working Group on paroxysmal nocturnal hemoglobinuria
Academic secretary of the seventh and eighth anemia group of Chinese hematology Association
Member of the Standing Committee of biotherapy of China Research Hospital Association
Member of Chinese society of hematoimmunology
Deputy leader of red blood cell disease group, hematology branch, Jiangsu Medical Association
Vice chairman of Jiangsu hematoimmunology Committee
Mainly engaged in the clinical and pathogenesis of hemocytopenia. He has successively participated in the national science and technology support plan and 863 project research, and is responsible for the innovative talents fund of Jiangsu Natural Science Foundation and the 135 key medical talents training fund. He has won the Chinese Medicine Award and the "Chen Jinrong Award for excellence in life science" of Suzhou University. He has published many articles and participated in the compilation of many academic monographs.
Editor: cici
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