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Blood, Vol. 95 No. 6 (March 15), 2000:
pp. 1931-1934
Antilymphocyte globulin, cyclosporine, prednisolone, and
granulocyte colony-stimulating factor for severe aplastic anemia: an
update of the GITMO/EBMT study on 100 patients
A. Bacigalupo,
B. Bruno,
P. Saracco,
E. Di Bona,
A. Locasciulli,
F. Locatelli,
A. Gabbas,
C. Dufour,
W. Arcese,
G. Testi,
G. Broccia,
M. Carotenuto,
P. Coser,
T. Barbui,
P. Leoni, and
A. Ferster for the
European Group for Blood and Marrow Transplantation (EBMT) Working
Party on Severe Aplastic Anemia and the Gruppo Italiano Trapianti di
Midollo Osseo (GITMO)
From Divisione Ematologia 2, Ospedale San Martino, Genova, Italy.
One hundred consecutive patients with severe aplastic anemia (SAA)
received horse antilymphocyte globulin (ALG), cyclosporin A (CyA),
6-methylprednisolone (6Mpred), and granulocyte colony-stimulating factor (G-CSF) as first-line therapy. The median age was 16 years (range, 1-72 years) and median neutrophil count was
0.2 × 109/L (range, 0-0.5 × 109/L).
Trilineage hematologic recovery (at a median interval of 96 days from
treatment) was seen in 77 patients (48 complete, 29 partial) after 1 (n = 50) or more courses of ALG (n = 27). Of the 23 nonresponders, 11 patients died at a median interval of 83 days (range,
16-1132 days), 6 were considered treatment failures and underwent
transplantation, and 6 were pancytopenic. Cytogenetic abnormalities
were seen in 11% of patients, clonal hematologic disease in 8%, and
relapse of marrow aplasia in 9%. The actuarial survival at 5 years was
87% (median follow-up 1424 days): 76% versus 98% for patients with
neutrophil counts less than versus greater than
0.2 × 109/L (P = .001) and 88% versus 87%
for patients aged less than versus more than 16 years
(P = .8). The actuarial probability of discontinuing CyA
was 38%. Patients who did not achieve a white blood cell (WBC) count
of 5 × 109/L during G-CSF treatment have a low
probability of responding (37%) and a high mortality rate (42%). This
update confirms a high probability for SAA patients of becoming
transfusion independent and of surviving after treatment with ALG, CyA,
6Mpred, and G-CSF, with a significant effect of neutrophil counts on
outcome. Problems still remain, such as absent or incomplete responses,
clonal evolution, relapse of the original disease, and cyclosporine
dependence. Early transplantation, also from alternative donors, may be
warranted in patients with poor WBC response to G-CSF.
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|
|
|
|
|
|
|
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135(7):
524 - 526.
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|
|
|
|
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