Treatment of adults with severe aplastic anemia: primary therapy with antithymocyte globulin (ATG) and rescue of ATG failures with bone marrow transplantation
| Autor: | Michael Crump, Jeffrey H. Lipton, J. E. Curtis, Ellen Maki, Loree M. Larratt, Hans A. Messner, Jacinta M. Meharchand, Mark D. Minden |
|---|---|
| Rok vydání: | 1992 |
| Předmět: |
Adult
medicine.medical_specialty Blood transfusion Adolescent Anemia medicine.medical_treatment T-Lymphocytes Salvage therapy Cancer Care Facilities Gastroenterology Severity of Illness Index Hemoglobins Leukocyte Count Clinical Protocols Adrenal Cortex Hormones Internal medicine Severity of illness medicine Humans Blood Transfusion Survival rate Antilymphocyte Serum Bone Marrow Transplantation Immunosuppression Therapy Ontario Salvage Therapy business.industry Histocompatibility Testing Anemia Aplastic Immunosuppression General Medicine Middle Aged medicine.disease Prognosis Combined Modality Therapy Surgery Hematopoiesis Survival Rate Leukemia medicine.anatomical_structure Treatment Outcome Cyclosporine Female Bone marrow business Follow-Up Studies |
| Zdroj: | The American journal of medicine. 92(6) |
| ISSN: | 0002-9343 |
| Popis: | purpose: To evaluate a policy of immunosuppression with antithymocyte globulin (ATG) as primary therapy for adults with severe aplastic anemia (SAA) regardless of the availability of an HLA-identical bone marrow donor. patients and methods: Thirty-one consecutive adults with SAA who satisfied the age criteria for allogeneic bone marrow transplantation (BMT) (age less than 51 years) were treated with ATG 20 mg/kg/day for 10 days along with high-dose corticosteroids. Patients with an HLAidentical donor received a transplant if they did not respond to ATG or if they developed lifethreatening complications during or soon after ATG administration. Eight patients with no response to ATG were also treated with oral cyclosporine 12.5 mg/kg/day. results: Eleven patients had a complete and five a partial response to ATG; two patients improved with cyclosporine treatment, resulting in an overall response rate of 58% to immunosuppression. Nine of 14 patients with donors received a BMT: seven because they did not respond to ATG and two because of serious infections. Seven grafts were obtained from related and two from unrelated donors. There was no significant difference in survival between those with and without a related HLA-identical donor (log-rank p value=0.969). At a median follow-up of 58 months, 26 of 31 are alive with an actuarial survival of 80% at 5 years. Two patients died of infection, two died from complications of BMT, and one remains transfusion-dependent. One patient died of refractory leukemia, at 30 months, one patient relapsed with hypoplasia 95 months after initial therapy with ATG. He showed a complete response to treatment with cyclosporine. No other late hematologic events have occurred. conclusions: This treatment approach resulted in the restoration of hematopoiesis and independence from transfusion in 80% of patients with SAA entered into the study. The efficacy of allogeneic BMT in salvaging cases in which ATG failed does not appear to be compromised. Follow-up for the development of clonal hematologic disorders remains an important part of this treatment policy. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|