The relapse rate following IS therapy may be substantial. For ATG/CsA, it may be as high as 35% in 7 years.1281 In general, relapse has a good prognosis and survival of relapsed patients is not significantly shortened.81 Patients with falling blood counts can receive a trial of CsA. If unsuccessful in rescuing the counts, a repeated course of ATG should be given. The response rates are likely comparable to those seen in the initial course of ATG. In some instances, rabbit ATG can be used instead of horse ATG, but it is unclear whether this measure helps to avoid more dramatic allergic reactions. High-dose cyclophosphamide (see above) has been suggested to prevent subsequent relapses.

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