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Antithymocyte Globulin


Presentation

  • IS-related serious adverse events (SAE) were reported in 47% of patients, with 4 presenting with cytomegalovirus infection and 4 (age, 42-59 years) diagnosed with cancer.[ncbi.nlm.nih.gov]
Intermittent Fever
  • The patient experienced intermittent fevers, polyarthralgia, and acute renal failure 9 days after completion of thymoglobulin administration. The patient's symptoms resolved rapidly and completely with a course of intravenous steroids.[ncbi.nlm.nih.gov]
Wound Infection
  • Patients were divided into those with previous MCSD DLI and those without, and they were assessed for 1-year freedom from infection (specifically, sternal wound infections).[ncbi.nlm.nih.gov]
Aspiration
  • A bone marrow aspiration revealed hypocellular marrow with morphologically blastoid cells. A surface marker study revealed the presence of a single clone that was positive for CD7, CD33, CD34, and HLA-DR.[ncbi.nlm.nih.gov]
  • Bone marrow biopsy and aspiration, including cytogenetic study, were performed before enrollment.[jamanetwork.com]
Jaw Pain
  • Jaw pain appears to be a hallmark symptom, and treatment with plasmapheresis and steroids relieves symptoms more rapidly than steroids alone.[ncbi.nlm.nih.gov]
Hypertrichosis
  • Side effects included hypertrichosis, gingival hyperplasia and mild reversible nephrotoxicity. CSA appears to represent an effective form of therapy for patients with SAA refractory to ATG.[ncbi.nlm.nih.gov]
Hyperactivity
  • In selected cases of aplastic anemia, with evidence of T-suppressor cell hyperactivity, treatment with ATG may offer an alternative approach to bone-marrow transplantation.[ncbi.nlm.nih.gov]

Workup

Pulmonary Infiltrate
  • The case of a 33-year-old man with aplastic anemia who experienced recurrent episodes of hypoxemia and pulmonary infiltrates during infusions of antithymocyte globulin (ATG) is described.[ncbi.nlm.nih.gov]

Treatment

  • ATG should be considered for the treatment of patients with red cell aplasia who fail to respond to glucocorticoid/alkylator treatment.[ncbi.nlm.nih.gov]

Prognosis

  • The clinical course was progressive and poor prognosis.[ncbi.nlm.nih.gov]
  • Historically, patients with severe aplastic anemia had a poor prognosis.[jamanetwork.com]
  • Introduction The worse prognosis of severe aplastic anemia (SAA) patients were not improved until the introduction of bone marrow transplant (BMT) and immunosuppressive therapy (IST) by antithymocyte globulin (ATG) [1], [2], [3], [4].[journals.plos.org]
  • Influence of surveillance renal allograft biopsy on diagnosis and prognosis of polyomavirus-associated nephropathy. Kidney Int. 2003;64(2):665–673. 66. Hirsch HH, Knowles W, Dickenmann M, et al.[dovepress.com]

Etiology

  • Since it is a syndrome of diverse etiologies, the optimal treatment is often uncertain. In a patient with longstanding AATP, a complete remission was obtained with antithymocyte globulin.[ncbi.nlm.nih.gov]

Epidemiology

  • Median creatinine of 6 patients excluded for acute kidney insufficiency at time of IVUS was 3.95 mg/dL with an estimated glomerular filtration rate of 17 mL/min by the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.[ahajournals.org]
  • One may hypothesize that the observed association constitutes another element of the "paradoxical" epidemiology seen in HF patients, where reduced fat mass, low cholesterol, and low blood pressure are linked with increased mortality.[revespcardiol.org]
  • Epidemiology of BK virus in renal allograft recipients: independent risk factors for BK virus replication. Transplantation. 2008;86(4):521–528. 62. Dharnidharka VR, Cherikh WS, Abbott KC.[dovepress.com]
Sex distribution
Age distribution

Pathophysiology

  • Although intravascular hemolysis after ATG administration appears to be uncommon, the clinical consequences may be severe, and determining the pathophysiology may yield clues to the mechanism of intravascular hemolysis.[ncbi.nlm.nih.gov]
  • On the basis of the immunologic pathophysiology of familial hemophagocytic lymphohistiocytosis, we propose a therapy with a combination of antithymocyte globulins with corticosteroids, cyclosporin A, and intrathecal injections of methotrexate.[pediatrics.aappublications.org]
  • Myelodysplastic syndrome and aplastic anemia—distinct entities or dieases linked by a common pathophysiology? Semin Hematol. 2000;37:15-29. Google Scholar 30. Maciejewski JP, Risitano AM, Nunez O, Young NS.[jamanetwork.com]
  • Current concepts in the pathophysiology and treatment of aplastic anemia. Blood. 2006;108:2509–19. [ Links ] 2. Naveiras O, Nardi V, Wenzel PL, Hauschka PV, Fahey F, Daley GQ.[scielo.br]
  • Young NS, Calado RT, Scheinberg P (2006) Current concepts in the pathophysiology and treatment of aplastic anemia. Blood 108:2509–2519 CrossRef PubMed PubMedCentral Google Scholar 14.[link.springer.com]

Prevention

  • We believe physicians should be aware of this common toxicity immediately after the administration of ATG to avoid any potential hepatotoxic drug before the resolution and to prevent any risk of hemorrhagic accident.[ncbi.nlm.nih.gov]
  • Anti-thymocyte globulin (rabbit) works by preventing the white blood cells from doing this. The effect of anti-thymocyte globulin (rabbit) on the white blood cells may also reduce the body's ability to fight infections.[mayoclinic.org]

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