+ Site Statistics
References:
52,654,530
Abstracts:
29,560,856
PMIDs:
28,072,755
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Treatment of Hepatitis-Associated Aplastic Anemia with Antithymocyte Globulin and Cyclosporine



Treatment of Hepatitis-Associated Aplastic Anemia with Antithymocyte Globulin and Cyclosporine



Blood 100(11): Abstract No 3514, November 16



H-AA is a variant of acquired aplastic anemia in which AA follows an episode of severe hepatitis. Although patients with H-AA were previously thought to have extremely poor prognosis, recent studies have shown favorable responses to intensive immunosuppressive therapy (IST). The aim of this study was to determine the IST response rate and survival rate of patients with H-AA. Between Jan 1993 and Sep 2001, 291 children with newly diagnosed AA were enrolled into two prospective multicenter trials. All of them received ATG (Lymphoglobulin, 15mg/kg/day, days 1 - 5) and CyA (6mg/kg/day, days 1 - 180). H-AA was defined as AA developed within 6 months after a documented episode of hepatitis. AA was associated with hepatitis in 42 patients (14%; age, 1-18 years, median age, 11 years, male to female ratio, 2 : 1). The virus causing the hepatitis was unkown in all of the patients. All but two patients fulfilled the criteria for severe disease. Thirty-one of 42 patients received G-CSF during follow - up. Six months after the start of ATG therapy, complete response was observed in 12 patients (27%) and partial response was observed in 17 (40%), for an overall response rate of 69%. Additional 2 patients became transfusion-independent between 6 and 12 months after treatment. Of the 31 patients with responses, no one had relapse after an initial response. There were four deaths, the causes of which were cytomegalovirus (CMV) - interstitial pneumonitis (2), bacteremia (1), and fungal pneumonia (1). Six non - responders received bone marrow transplantation (BMT) from an HLA - matched unrelated donor, all of whom are alive and well. New clonal abnormalitiy of del (13) appeared in one patient 18 months after the diagnosis of H-AA, in whom distinctive morphologic features of myelodysplastic syndrome were not found. He is alive and transfusion - independent 85 months after initial diagnosis.Actuarial 8 - year survival was 90% (95%CI; 85% - 95%), which reflects the results of salvage therapy using alternative donor BMT as well as the initial IST. It is noteworthy that CMV - pneumonitis developed only in patients with H-AA and none of 249 patients with other etiologies had this complication after IST.

(PDF emailed within 1 workday: $29.90)

Accession: 035980495

Download citation: RISBibTeXText


Related references

Antithymocyte globulin and cyclosporine for treatment of 44 children with hepatitis associated aplastic anemia. Haematologica 92(12): 1687-1690, 2007

The efficacy of rabbit antithymocyte globulin with cyclosporine in comparison to horse antithymocyte globulin as a first-line treatment in adult patients with severe aplastic anemia: a single-center retrospective study. Annals of Hematology 92(6): 817-824, 2013

Report on a randomized trial comparing cyclophosphamide and cyclosporine vs antithymocyte globulin and cyclosporine as initial treatment for severe aplastic anemia. Blood 94(10 SUPPL 1 PART 1): 407a, Nov 15, 1999

Immunosuppressive treatment of aplastic anemia with antithymocyte globulin and cyclosporine. Seminars in Hematology 37(1): 56-68, 2000

Immunosuppressive treatment of aplastic anemia in Chinese children with antithymocyte globulin and cyclosporine. Pediatric Hematology and Oncology 23(1): 45-50, 2005

An Epstein-Barr virus-associated leukemic lymphoma in a patient treated with rabbit antithymocyte globulin and cyclosporine for hepatitis-associated aplastic anemia. Acta Haematologica 127(2): 96-99, 2012

Intensive immunosuppression with antithymocyte globulin and cyclosporine as treatment for severe acquired aplastic anemia. Blood 85(11): 3058-3065, 1995

Antithymocyte/Antilymphocyte globulin plus cyclosporine A therapy for the treatment of older patients with severe aplastic anemia. Zhonghua Xue Ye Xue Za Zhi 37(7): 607-610, 2016

Antithymocyte globulin, cyclosporine, and prednisone for the treatment of severe aplastic anemia in children. A pilot study. American Journal of Pediatric Hematology/Oncology 16(2): 104-106, 1994

10 years results of a German phase III trial evaluating treatment of aplastic anemia with antithymocyte globulin with or without cyclosporine A. Blood 94(10 SUPPL 1 PART 1): 674a, Nov 15, 1999

Multicenter randomized study comparing cyclosporine-A alone and antithymocyte globulin with prednisone for treatment of severe aplastic anemia. Blood 79(10): 2540-2546, 1992

Successful treatment of severe aplastic anemia in children using standardized immunosuppressive therapy with antithymocyte globulin and cyclosporine A. Pediatric Blood & Cancer 43(7): 718-722, 2004

Prospective study of rabbit antithymocyte globulin and cyclosporine for aplastic anemia from the EBMT Severe Aplastic Anaemia Working Party. Blood 119(23): 5391-5396, 2012

Treatment of severe aplastic anemia with a combination of horse antithymocyte globulin and cyclosporine, with or without sirolimus: a prospective randomized study. Haematologica 94(3): 348-354, 2009

Rabbit antithymocyte globulin versus horse antithymocyte globulin for treatment of acquired aplastic anemia: a retrospective analysis. Annals of Hematology 94(6): 947-954, 2015