Anti-thymocyte globulin (ATG) can eliminate platelet refractoriness

An animal model of alloimmune thrombocytopenia. I. The role of the mononuclear phagocytic system (MPS)

To understand better the role of the mononuclear phagocytic system (MPS) in accelerated destruction of donor platelets in man following repeated platelet transfusions, an experimental model has been developed using genetically defined animals. Brown Norway rats were immunized with Lewis platelets. Antibodies were detected by immunofluorescence microscopy, and their effects demonstrated by 111In-labeled platelet clearances in vivo and by measurements of organ radioactivity in sacrificed animals. All immunized rats developed platelet alloantibodies and showed a significant decrease (P less than 0.001) in donor platelet survival with sequestration in both the liver and spleen. Liver to spleen radioactivity ratios in nonimmunized animals were less than 0.1, whereas immunized animals had a ratio between 0.6 and 1.0, indicating relatively greater hepatic clearance of allogenic platelets. Studies currently in progress on the administration of vinca alkaloids to immunized animals suggest that the MPS can be impaired from clearing allogenic platelets. This model, therefore, should be helpful in studying the role of the MPS in platelet destruction.

Anti-thymocyte globulin treatment for aplastic anemia

20 patients with severe aplastic anemia were treated with anti-thymocyte globulin (ATG), 6 of them in combination with haplo-identical bone marrow. 7 patients (35%) showed a good clinical response within 6 months; they were off transfusions and had greater than or equal to 0.8 x 10(9)/l neutrophils. ATG had the greatest effect on red-cell production and the least on platelet production. The hematological recovery with ATG could not be predicted from the bone-marrow histology, CFU-c growth, or clinical data. However, patients with strong HLA antibodies seemed to respond more often. The actuarial survival was 55% at 5 years. Under intensive supportive care, even 7 out of 12 non-responders were alive after 1 year. ATG appears to be a useful form of therapy for patients with severe aplastic anemia who are not candidates for bone-marrow transplantation.