1. ZONGHONG SHAO BLOOD DISEASE HOSPITAL CAMS & PUMC
ANTITHYMOCYTE GLOBULIN: A CORNERSTONE IN THE TREATMENT OF SEVERE APLASTIC ANEMIA
ZONGHONG SHAO
BLOOD DISEASE HOSPITAL
CAMS & PUMC

2. MAIN POINTS TO BE TALKED TODAY
HISTORY LESSONS
THE CONTRIBUTION OF ATG IN THE TREATMENT OF SAA
GAP BETREEN DESTINATION AND WHERE WE ARE
PROSPECTION
HOW TO INCREASE FURTHER THE RESPONSE OF SAA TO ATG

3. ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

4. ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

5. ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES
BEFORE ATG AFTER ATG

6. ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

7. ATG CONTRIBUTION (I) SALVAGING SAA PATIENT’S LIVES

8. ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

9. ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

10. ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

11. ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

12. ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION
骨髓细胞IFN-γ、IL-4m-RNA的表达
组别 例数 IFN-γ（%） IL-4（%）
AA组
SAA （81.3%) (6.3%)
CAA (54.5%) (9.1%)
病例对照
PNH
MDS
AL (20.0%)
IRP (44.4%)
正常对照

13. ATG CONTRIBUTION (II) REMINDING PEOPLE OF SAA T-CELL OVERFUNCTION

14. HISTORY LESSONS ATG CONTRIBUTION
A CORNERSTONE THERAPY FOR RESCURING SAA PATIENTS
AN PATHOGENIC INDICATOR FOR SAA T-CELL OVERFUNCTION

15. HISTORY LESSONS GAP BETREEN DESTINATION AND WHERE WE ARE
RESPONSE RATE IMPROVEMENT IS IN NEED
SAA IS STILL A LETHAL DISEASE IN QUITE MORE MEDICAL CENTERS .
EVEN IN THE CENTERS WITH HIGHER QUALITY, THERE ARE STILL 10%~20%OF SAA CASES DIED .
ATG USAGE SHOULD BE MODIFIED PROPERLY
ATG WAS USED IN SOME NON-T-CELL-OVERFUNCTION RELATED BM FAILURE.
ATG WAS USED IN SOME WRONG WAYS, SUCH AS ONCE A WEEK INTRAVEINOUSLY.
NO ENOUGH TIME WAS LEFT FOR ATG TO RESTORE SAA BM: THERAPY WAS SHIFTED TOO FREQUENTLY

16. HOW TO INCREASE FURTHER SAA RESPONSE TO ATG
DIAGNOSING SAA CORRECTLY
BETTER CONDITIONING THERAPY
PROPER ATG USAGE
OPTIMUM COMBINING THERAPY
ENOUGH SUPPORTIVE THERAPY
ENOUGH CONSOLIDATION
CLOSELY FOLLOWING UP

17. DIAGNOSING SAA CORRECTLY
Idiopathic
Severe pancytopenia
Reticulocyte
Neutrophil
Platelet
Severe and broader BM failure
T-cell overfunction
Excluding other kinds of BM failures

18. BETTER CONDITIONING THERAPY
CONTROLLING INFECTION
PATHOGENIC GERMS CULTURES
ANTIINFECTION
ISOLATING SAA PATIENTS
HEMOSTASIS
ELEVATING Hb LEVEL
KEEPING KEY ORGANS IN GOOD CONDITION

19. PROPER ATG USAGE ALLERGIC TEST DAILY DOSE COURSE RE-USING
10mg of ATG+NS100cc iv gtt for 1 hour
Careful observation and antiallergy medicines in ready
No corticosteroids used
DAILY DOSE
3~5mg/kg/d equally divided and solved into 2 ×500cc of NS, 500cc iv gtt for 6~8 hours
1mg of pred /kg/d used simultaniusly
COURSE
5days
RE-USING
FOR THOSE WHO HAVE NO ANY RESPONSE TO 1TH COURSE OF ATG AFTER 1 YEAR FOLLOWING UP
USING NEW KIND OF ATG (DIFFERENT ANIMAL SPECIES)

20. OPTIMUM COMBINING THERAPY
CYCLOSPORIN
LOWER DOSE, LONGER COURSE
SERUM LEVEL SERVILLANCE
SIDE EFFECTS
ANDROGEN
HGFs
HIGHER DOSE, LONGER COURSE

21. ENOUGH SUPPORTIVE THERAPY
ANTIINFECTION
CONTROLLING HEMARRAGES
RBC TRANSFUSION
NUTRITION SUPPLYMENT
PSYCOLOGY CARE

22. ENOUGH CONSOLIDATION BASED ON THE CLOSELY FOLLOWING UP TIME PBC
BM ( INCLUDING BIOPSY AND CULTURE)
T-CELL FUNCTION
TIME
4 YEARS, NO RELAPSE
3 YEARS, FEW RELAPSE
2 YEARS LESS, SOME RELAPSE

23. MANY THANKS !