Aplastic Anemia | Comparison of Two Different Doses of Rabbit ATG-Fresenius With Cyclosporin in the Treatment of Acquired Aplastic Anaemia
Aplastic Anemia research study
What is the primary objective of this study?
Acquired Aplastic anemia is one of the most frequent reason of bone marrow failure in East (Pakistan). - The first treatment option is Allogenic Bone Marrow transplantation which is an expansive treatment option and also require a full matched HLA identical donor, hence hardly 25% of our affected patients get opportunity for BMT. - The second line treatment option caters a large chunk of patients (severe and non-severe AA) along with those who lack HLA identical donor. Previously many protocols had been used in past for ATG+CsA Treatment, this treatment protocol especially addresses the two different regimens of ATG to study its efficacy, durability and long-term effects. Following doses would be used: - CsA+ATG @ 10mg/kg for 3 days - CsA+ATG @ 10mg/kg for 5 days
Who is eligible to participate?
Inclusion Criteria: i. Severe aplastic anemia characterized by: Bone marrow cellularity <30% (excluding lymphocytes) AND At least two of the following: a. Absolute neutrophil count < 500/ uL b. Platelet count < 20,000/ uL c. Absolute reticulocyte count <60,000/ uL i. Age > 2 years old ii. Weight > 9 kg Exclusion Criteria: i. Diagnosis of Fanconi's anemia ii. Evidence of a clonal disorder on cytogenetics. Patients with very severe neutropenia (ANC < 200 /uL) will be excluded iii. Failure of BMT iv. Prior immunosuppressive therapy with ATG, ALG, alemtuzumab, or high dose cyclophosphamide v. Infection not adequately responding to appropriate therapy vi. Serologic evidence of HIV infection vii. Failure to discontinue the herbal supplements or Other alternative approach of treatment within 2 weeks of enrolment viii. Moribund status or concurrent hepatic, renal, cardiac, neurologic, pulmonary, infectious, or metabolic disease of such severity that it would preclude the patient's ability to tolerate protocol therapy, or that death within 7-10 days is likely ix. History of carcinoma that is not considered cured (except local cervical, basal cell, or squamous cell) x. Current pregnancy, or unwillingness to take oral contraceptives or refrain from pregnancy if of childbearing potential xi. Not able to understand the investigational nature of the study or give informed consent
Which medical condition, disease, disorder, syndrome, illness, or injury is researched?
Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.
Drug:ATG-freseniuswe will create 2 arms as per randomization table. Both arms will receive ATG-Fresenius but with 2 different regimens. the first arm will receive ATG-F @10mg/kg for 3 days and second arm will receive ATG-F same dose but for 5 days
Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.
ATG-Fresenius 3 DaysIn one group Injection ATG-Fresenius will be given @ 10mg/kg will be given for 3 days along with Capsule Cyclosporin 5mg/kg for 6 months followed by very slow tapering of dose
ATG-Fresenius 5 DaysIn other arm injection ATG will be given @10mg/Kg for 5 days (different dose regimen, according to the randomization) with capsule Cyclosporin@5mg/Kg (same dose) for 6 months followed by very slow tapering. There is a difference of days of treatment received i-e 5 days.
Start Date: September 2013
Completed Date: December 2017
Primary Outcome: absolute blood counts not meeting the criteria of Aplastic Anemia
Secondary Outcome: transfusion dependency after ATG treatment
Study sponsors, principal investigator, and references
Principal Investigator: TAHIR S SHAMSI, MBBS,FRCPath
Lead Sponsor: National Institute of Blood Disease Center, Pakistan