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Antilymphocyte Globulin Therapy for Aplastic Anemia in Children

Journal of the Korean Pediatric Society 1994;37(11):1526-1539.
Published online November 15, 1994.
Antilymphocyte Globulin Therapy for Aplastic Anemia in Children
Soo Jong Hong1, Hee Young Shin2, Hyo Seop Ahn2
1Department of Pediatrics, College of Medicine University of Ulsan, Seoul, Korea
2Department of Pediatrics, Seoul National University, College of Medicine, Seoul, Korea
재생불량성빈혈 환아에서 Antilymphocyte Globulin 면역요법에 관한 연구
홍수종1, 신희영2, 안효섭2
1울산대학교 의과대학 소아과학교실
2서울대학교 의과대학 소아과학교실
Abstract
Immunosuppressive therapy based on the use of antilymphocyte globulin (ALG) has become standard therapy for patients with aplastic anemia who are not eligible for bone marrow transplantation. In this study, T cell subsets before and after ALG therapy, hematologic responses, complications and prognostic factors were analysed. Eleven (42%) out of twenty-six patients treated with ALG showed response, but two patients showed relapse. Most of the response (9cases) was noticed within 6 months after the initiation of ALG therapy (median: 3 months). The main complications of ALG therapy were fever (91%), thrombocytopenia(86%), neutropenia (63%), and serum sickness (56%). Four patients were died just after ALG therapy because of serum sickness (2 cases), intracranial hemorrhage (1cases), and shock (1 cases). Short interval from diagnosis to treatment suggested to show good response (P=0.0575), but it was not significant statistically. Lymphocyte substes were measured in the blood of 23 patients. Helper T/ suppressor T cell ratio (T4/T8 ratio) at the initiation of ALG therapy(day 0) was higher significantly in patients who were responded( P=0.0299). The patients who showed above 1.0 of T4/T8 ratio on day 0 might be speculated good response (P=0.032). More difference of T4/T8 ratio between day 14 after ALG therapy and day 0 might show good response(P=0.0673). Then the actuarial probability of survival at 3 years in patients treated with ALG was 77%. Our data suggest that ALG therapy may be used as an alternative treatment to bone marrow transplantation, and T4/T8 ratio of peripheral blood at the initiation of therapy may be used as one of the prognostic factors.
Key Words: Aplastic anemia, Antilymphocyte globulin, Prognostic factor, T cell subset, Helper T/ suppressor T cell ratio


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