what is better in 2nd ATG? repeat H-ATG or try R-ATG?

[pvinod]

Hi My daughter had an H-ATG in Dec-2010. but still no response. Nutrophil is only 6 and lymphocytes is 93.

so in 2nd ATG what is better? Is it good to repeat H-ATG again or do we have to try R-ATG?

[Karenish]

I think they will try horse as she had horse first. i am the same, nothing really major in my counts, so we are looking at rabbit again as it was rabbit first. I think they stick with the same because they know how the body will react to it, but i am sure someone more knowledgeable may know. However, get them to check for any cellular activity in her marrow first, some people dont respond until month 10 I have heard but checking may show that there is a response but it is slow. good luck, i do know how it feels to be ever hopeful at every blood test only to be disappointed with each call, saying they are going down again, and in you go for yet another transfusion. I am getting two bags of plates again tomorrow....been 15 days since my last one!

[Lisa V]

This is a very difficult question to answer. If your daughter had shown a response, even a small one, to the first round of H-ATG, then I'd say to repeat the horse. That's what we did, and I'm glad we did, particuarly since recent studies have shown that H-ATG is more effective than R-ATG as a first line therapy.

On the other hand, R-ATG is still useful for salvage therapy, meaning when the first line of treatment hasn't been successful. I'm not sure whether or not it would be worth trying again with the horse in this case. I think if we had seen no response at all the first time we might have switched, but I imagine every doctor has their own opinion on this.

Has anyone else come across any recent statistics on horse vs. rabbit for salvage therapy? I tried searching and couldn't find anything.

[Hopeful]

Hi Lisa and pvinod,

I remember from one of the conference speakers that Rabbit ATG is typically used for salvage treatment because of the fear that a patient may have a more severe reaction to the therapy the second time around (like anaphylaxis shock). One of the people in the audience commented that this had happened to her! There haven't been official studies comparing the two at NIH.

The response rate to a second course of ATG in a non-responder is about 1 in 3 - not as common as the first course, but still possible.