scholarly journals Treatment of acquired severe aplastic anemia with antilymphocyte globulin, cyclosporin A, methyprednisolone, and granulocyte colony-stimulating factor

2007 ◽  
Vol 82 (9) ◽  
pp. 783-786 ◽  
Author(s):  
Günçağ Dinçol ◽  
Melih Aktan ◽  
Reyhan Diz-Küçükkaya ◽  
Selim Yavuz ◽  
Meliha Nalçacı ◽  
...  
Keyword(s):  
Cyclosporin A ◽  
Aplastic Anemia ◽  
Severe Aplastic Anemia ◽  
Granulocyte Colony Stimulating Factor ◽  
Antilymphocyte Globulin ◽  
Colony Stimulating Factor ◽  
Stimulating Factor ◽  
Acquired Severe Aplastic Anemia

Antilymphocyte globulin, cyclosporin, and granulocyte colony- stimulating factor in patients with acquired severe aplastic anemia (SAA): a pilot study of the EBMT SAA Working Party

Blood ◽  
1995 ◽  
Vol 85 (5) ◽  
pp. 1348-1353 ◽  
Author(s):  
A Bacigalupo ◽  
G Broccia ◽  
G Corda ◽  
W Arcese ◽  
M Carotenuto ◽  
...  
Keyword(s):  
Pilot Study ◽  
Aplastic Anemia ◽  
Working Party ◽  
Early Mortality ◽  
Severe Aplastic Anemia ◽  
Granulocyte Colony Stimulating Factor ◽  
Antilymphocyte Globulin ◽  
Colony Stimulating Factor ◽  
Stimulating Factor

Patients with severe aplastic anemia (SAA) and a neutrophil (PMN) count of less than 0.5 x 10(9)/L are exposed to a high risk of early mortality when treated with antilymphocyte globulin (ALG) and steroids, with the major problem being infectious complications. The addition of human recombinant granulocyte colony-stimulating factor (rhG-CSF) to ALG may reduce early mortality by improving neutrophil counts in the short term. To test the feasibility of this approach, the SAA Working Party of the European Group for Blood and Marrow Transplantation (EBMT) designed a pilot study that included rhG-CSF (5 micrograms/kg/d, days 1 through 90), horse ALG (HALG; 15 mg/kg/d, days 1 through 5), methylprednisolone (2 mg/kg/d, days 1 through 5, then tapering the dose), and cyclosporin A (CyA; 5 mg/kg/d orally, days 1 through 180). Patients with newly diagnosed acquired SAA (untreated) and with neutrophil counts of < or = 0.5 x 10(9)/L were eligible. Forty consecutive patients entered this study and are evaluable with a minimum follow up of 120 days: the median age was 16 years (range, 2 to 72 years), the interval from diagnosis to treatment was 24 days, and the median PMN count was 0.19 x 10(9)/L. Twenty-one patients had hemorrhages, and 19 were infected at the time of treatment. Overall, treatment was well tolerated: the median maximum PMN count during rhG- CSF administration was 12 x 10(9)/L (range, 0.4 x 10(9)/L to 44 x 10(9)/L). There were three early deaths (8%) due to infection. Four patients (10%) showed no recovery, whereas 33 patients (82%) had trilineage hematologic reconstitution and became transfusion- independent at a median interval of 115 days from treatment. Median follow up for surviving patients is 428 days (range, 122 to 1,005). Actuarial survival is 92%: 86% and 100% for patients with PMN counts less than 0.2 x 10(9)/L or between 0.2 x 10(9)/L and 0.5 x 10(9)/L, respectively. This study suggests that the addition of rhG-CSF to ALG and CyA is well tolerated, is associated with a low risk of mortality, and offers a good chance of hematologic response. This protocol would appear to be an interesting alternative treatment for SAA patients with a low PMN count who lack an HLA-identical sibling.

Antilymphocyte globulin, cyclosporine, prednisolone, and granulocyte colony-stimulating factor for severe aplastic anemia: an update of the GITMO/EBMT study on 100 patients

Blood ◽  
2000 ◽  
Vol 95 (6) ◽  
pp. 1931-1934 ◽  
Author(s):  
A. Bacigalupo ◽  
B. Bruno ◽  
P. Saracco ◽  
E. Di Bona ◽  
A. Locasciulli ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Clonal Evolution ◽  
Severe Aplastic Anemia ◽  
Granulocyte Colony Stimulating Factor ◽  
Antilymphocyte Globulin ◽  
Colony Stimulating Factor ◽  
Actuarial Survival ◽  
First Line Therapy ◽  
Stimulating Factor ◽  
Median Interval

Abstract 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.

Trilineage Response in Severe Aplastic Anemia Following Long-Term Therapy with Recombinant Human Granulocyte Colony-Stimulating Factor

1993 ◽  
Vol 90 (3) ◽  
pp. 159-161 ◽  
Author(s):  
Eishi Ashihara ◽  
Chihiro Shimazaki ◽  
Toshiyuki Hirata ◽  
Katsunori Okawa ◽  
Naritoshi Oku ◽  
...  
Keyword(s):  
Aplastic Anemia ◽  
Severe Aplastic Anemia ◽  
Term Therapy ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Long Term Therapy ◽  
Stimulating Factor
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