| Immunomodulation Therapy in Aplastic Anemia : Relapse Rate, Complications
and Long-term Survival During Follow-up for More than 1 Year |
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Jun Ah Lee, Hyoung Jin Kang, Hyo Jeong Han, Hyoung Soo Choi, Eun Sun Yoo, Hee Young Shin, Joong Gon Kim, Hyo Seop Ahn |
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Department of Pediatrics, Seoul National University College of Medicine Seoul, Korea |
| 재생불량성 빈혈에서의 면역조절 요법 - 1년 이상 추적 관찰시의 재발률, 합병증, 장기 생존율 - |
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이준아, 강형진, 한효정, 최형수, 유은선, 신희영, 김중곤, 안효섭 |
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서울대학교 의과대학 소아과학교실 |
Correspondence:
Hyo Seop Ahn, Email: 1
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| Abstract |
Purpose
: We evaluated the response to immunomodulation therapy, long-term survival and relapse
rate of aplastic anemia during follow-up for more than 1 year.
Methods
: Twenty-eight children, with moderate to severe aplastic anemia were followed for more
than one year and 7 children expired after therapy, were analyzed. Antilymphocyte globulin(ALG) or
antithymocyte globulin(ATG) by itself was given to 27 patients, and cyclosporine A(CsA) combined
with ALG was given to 8 patients. ALG(ATG) was administered for 8 days in 20mg/kg/day when
used alone, and for 5 days in 10mg/kg/day when combined with CsA. CsA was orally administered
on the 14th day till 180th day of therapy, with 5mg/kg/day for first 14 days and 3mg/kg/day
thereafter.
Results
: Fifteen out of 35 patients(43%) showed a response. Median interval to response was 3
month(1-40 months). Response rate to ALG＋CsA was 50%, compared to 41% in ALG(or ATG)
alone. The interval of aplastic anemia symptoms to treatment showed a tendency to be shorter in
responders(4.1±2.2 months) than in non-responders(17.5±6.4 months). Relapse occurred in 3 of 15
responders(20%). Evolution to secondary clonal hematologic disorders was not observed. Overall
actuarial survival at 3 year was 78.2%
Conclusion
: The results of immunomodulation therapy suggest that response would be better for
patients whose interval from symptoms of aplastic anemia to treatment is short. Our results also
suggest that ALG＋CsA would be a better treatment modality to improve response rate. |
| Key Words:
Aplastic anemia, Immunomodulation therapy, Antilymphocyte globulin, Antithymocyte globulin, Cyclosporine A |
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