ANTILYMPHOCYTE GLOBULIN THERAPY FOR PAROX YSMAL-NOCTURNAL HEMOGLOBINURIA

Objective. To evaluate the effectiveness of antilymphocyte globulin th erapy (ALG) in patients with paroxysmal nocturnal hemoglobinuria (PNH) . Design. Prospective, non-controlled trial. Setting. Hematology Servi ce, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, IMSS , Mexico City. Patients. Six patients were included. The median age wa s 37.5 years and the male/female ratio was 1:1.All the patients had cl inical disease consistent with PNH (hemolytic anemia with some degree of transient or persistent pancytopenia) and also erythrocytes with en hanced sensitivity to complement mediated lysis in vitro, as documente d by either the Ham test or the sucrose lysis assay. The criterion for severity was the existence of continuous hemolysis in all and transfu sion requirements of two or more packed red cells per month in four ca ses. Prior to ALG therapy, androgens and/or steroids had been given to five patients with no improvement. Intervention. A single batch of AL G was used during the trial (E 0034, Lymphoglobulin Merieux, Lyon, Fra nce). Patients received an infusion of 10 mg/kg per day in a 20 hours lapse during four consecutive days. Also 500 mg/day of methylprednisol one were started simultaneously with the ALG; it was given for seven d ays and was gradually tapered off and stopped on day 30. Measurements. The increases in hemoglobin, granulocytes and/or platelets as well as decreases in red cell transfusion requirements were used to evaluate the results of therapy. Results. Two patients suffered anaphylaxis aft er the first administration of ALG and were withdrawn from the study. Two of the four remaining patients responded, one response was total a nd the other minimal. The responses were transient, and no response wa s seen in the follow-up of 11-14 months. Conclusion. ALG therapy for P NH in the doses and time periods used by us had no beneficial effect i n patients with a severe form of PNH.