PURPOSE: Acquired aplastic anemia is an organ-specific auto-immune disease characterized by pancytopenia and hypoplastic bone marrow. Immunosuppression with anti-thymocyte globulin (ATG) and cyclosporine A (CsA) is an effective and safe therapy for patients without undergoing hematopoietic stem cell transplantation. The aim of the current study was to investigate the effect of rabbit-ATG (r-ATG) combined with CsA as an intensive immunosuppressive therapy (IST) for acquired severe aplastic anemia (SAA) in children. METHODS: From January 2003 to November 2008, 46 children (30 boys and 16 girls), with a median age of 7 years (between 2 and 15 years) were diagnosed with acquired SAA. They received an IST of r-ATG combined with CsA. The average time was 3.4 months (ranging from 1 to 13 months). The effective rates 3, 6, 9, and 12 months after treatment were 30.4, 65.2, 78.8, and 84.8%, respectively. After 2 years of follow-up, the response rate was 84.8% (39/46). No response was found in five cases and relapse was found in two. RESULTS: Among the five cases without response, two received unrelated hematopoietic stem cell transplantation and are already disease-free and two died from infection caused by long-term dependence on infusion. No myelodysplastic syndrome or acute myeloid leukemia was found among the patients. CONCLUSIONS: We propose that r-ATG combined with CsA as an intensive IST is effective and safe in treating acquired SAA in children.
PURPOSE: Acquired aplastic anemia is an organ-specific auto-immune disease characterized by pancytopenia and hypoplastic bone marrow. Immunosuppression with anti-thymocyte globulin (ATG) and cyclosporine A (CsA) is an effective and safe therapy for patients without undergoing hematopoietic stem cell transplantation. The aim of the current study was to investigate the effect of rabbit-ATG (r-ATG) combined with CsA as an intensive immunosuppressive therapy (IST) for acquired severe aplastic anemia (SAA) in children. METHODS: From January 2003 to November 2008, 46 children (30 boys and 16 girls), with a median age of 7 years (between 2 and 15 years) were diagnosed with acquired SAA. They received an IST of r-ATG combined with CsA. The average time was 3.4 months (ranging from 1 to 13 months). The effective rates 3, 6, 9, and 12 months after treatment were 30.4, 65.2, 78.8, and 84.8%, respectively. After 2 years of follow-up, the response rate was 84.8% (39/46). No response was found in five cases and relapse was found in two. RESULTS: Among the five cases without response, two received unrelated hematopoietic stem cell transplantation and are already disease-free and two died from infection caused by long-term dependence on infusion. No myelodysplastic syndrome or acute myeloid leukemia was found among the patients. CONCLUSIONS: We propose that r-ATG combined with CsA as an intensive IST is effective and safe in treating acquired SAA in children.
Authors: Manuel G Afable; Mohammed Shaik; Yuka Sugimoto; Paul Elson; Michael Clemente; Hideki Makishima; Mikkael A Sekeres; Alan Lichtin; Anjali Advani; Matt Kalaycio; Ramon V Tiu; Christine L O'Keefe; Jaroslaw P Maciejewski Journal: Haematologica Date: 2011-05-23 Impact factor: 9.941
Authors: Anthony N Audino; Julie Blatt; Benjamin Carcamo; Victoria Castaneda; Patricia Dinndorf; Winfred C Wang; James A Whitlock; Jeffrey D Hord Journal: Pediatr Blood Cancer Date: 2010-02 Impact factor: 3.167