演題詳細

一般口演 / Oral Session

一般口演 74 (Oral Session 74) :貧血の臨床

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日程
2013年10月13日(日)
時間
08:45 - 09:45
会場
第4会場 / Room No.4 (さっぽろ芸文館 3F 黎明)
座長・司会
亀岡 淳一 (Junichi Kameoka):1
1:東北大学 血液・免疫病学分野
 
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Immunosuppressive therapy with rabbit ATG for moderate and severe aplastic anemia

演題番号 : OS-3-14

小笠原 洋治 (Yoji Ogasawara):1、海渡 健 (Ken Kaito):1、乾 由美子 (Yumiko Inui):1、鈴木 一史 (Kazuhito Suzuki):1、町島 智人 (Tomohito Machishima):1、神山 祐太郎 (Yutaro Kamiyama):1、勝部 敦史 (Atsushi Katsube):1、横山 洋紀 (Hiroki Yokoyama):1、齋藤 健 (Takeshi Saito):1、杉山 勝紀 (Katsuki Sugiyama):1、高原 忍 (Shinobu Takahara):1、矢萩 裕一 (Yuichi Yahagi):1、矢野 真吾 (Shingo Yano):1、西脇 嘉一 (Kaichi Nishiwaki):1、土橋 史明 (Nobuaki Dobashi):1、島田 貴 (Takaki Shimada):1、薄井 紀子 (Noriko Usui):1、相羽 惠介 (Keisuke Aiba):1

1:Div. of Clin. Oncol. and Hematol., Jikei Univ., Japan

 

Immunosuppressive therapy (IST) with anti-thymocyte globulin (ATG) plus cyclosporine (CyA) is the initial strategy for severe aplastic anemia (AA). Recently, rabbit ATG (rATG) has been approved for AA. Although the approved dose of rATG ranges from 2.5 to 3.75mg/kg/day, efficacy and safety for Japanese patients remain unclear. To assess these problems, we investigated 12 patients (male/female=3/9, age 22-73 years, idiopathic/post-hepatitis/AA-PNH=10/1/1, stage 2/3/4/5=3/2/5/2) who had received IST with rATG/CyA from 2008 to 2012. Seven patients received rATG at a dose of 3.75mg/kg/day on days 1-5, another 2 patients required a dose reduction of rATG on day 2 and day 3 due to severe adverse events (AE), and the other 3 patients received rATG at a dose of 3.5mg/kg/day, 2.5mg/kg/day, and 2.0mg/kg/day, respectively. The hematologic response rate (RR) at 3, 6, and 9 months after IST was 41.6% (CR 1/12, PR 4/12), 63.6% (CR 1/11, PR 6/11), and 63.6% (CR 2/11, PR 5/11), respectively. The early non-hematologic AE were pyrexia (83%), skin eruption (67%), and liver damage (42%; grade3 17%). Sepsis was observed in 2 patients on days 2-3, and cytomegalovirus (CMV) reactivation was observed in 6 patients treated with rATG at 3.75mg/kg/day. Ebstain-Barr Virus (EBV) reactivation was also observed in 5 patients treated with rATG at 3.5-3.75mg/kg/day. One patient developed lymphoproliferative disease, which was treated with Rituximab. These data suggest that although IST with rATG (3.75mg/kg/day)/CyA is effective, monitoring for reactivation of CMV and EBV is essential for its safety.

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