Publication

Abstract : Objective The aim of the study was to confi rm the effi cacy of treatment with horse anti-thymocyte globulin (h-ATG) in patients of idiopathic aplastic anaemia (AA). Methodology 03 of AA were studied. Only patients followed for at least 3 months and 6 months in order to assess the response to the treatment were included in the analysis. The diagnosis of AA was established as per described criteria. All the patients were given equine ATGATGAM. ATGAM was used in the dose of 40mg/kg/day (total dose 160mg/kg) for 4 consecutive days. Those who could not afford, ATGAM was used in lower doses also i.e. 20mg/kg/day (total dose 80mg/kg) for 4 consecutive days, and 15mg/kg/day (total dose 75mg/kg) for 5 consecutive days. All remission had to be confi rmed by at least 2 blood counts at least 4 week apart. A patient was considered in relapse if he or she had transfusions with red blood cells or platelets after having been independent from transfusions for at least 3 months. Results Out of 103 patients 6 patients were died before 3 months and in consequence were excluded from the fi nal analysis, which was made in 97 patients. There were 66 male and 31 female with a median age of 27 years (range, 2.5-75 years). Thirty four patients were received 160mg/kg, 13 patients in 80mg/kg and 50 patients in 75mg/kg. The median interval from diagnosis to treatment was 120 days (range, 30-2,160 days). At 3 months 6 patients had CR, 33 patients PR and 58 had no response. The overall response rate of 42.20% was achieved. At 6 months 10 patients had CR, 43 patients PR and 44 had no response. The overall response rate of 54.63% was achieved. Fifteen patients relapsed at a median interval of 360 days from treatment (range, 225-1,050 days). The actuarial survival at 4 years those who responded was 89.58% versus 61.29% those who not responded. The 3 months response rate was 44.11%, 30.76%, 40% and 6 months response rate was 61.76%, 53.84%, 52% with using total dose 160mg/kg, 80mg/kg, 75mg/kg respectively. There was no signifi cant difference in response rate but the cost of 40mg/kg for 4 days was double compare with total dose 80mg/kg and 75mg/kg. Conclusion So, from our study low dose ATG may be one of the treatment options in the resource poor developing countries like India.