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Treatment of severe aplastic anemia: comparison between bone marrow transplantation and immunomodulation.

Journal of the Korean Pediatric Society 1991;34(2):172-179.
Published online February 28, 1991.
Treatment of severe aplastic anemia: comparison between bone marrow transplantation and immunomodulation.
Dae Chul Jeong, Sung Dong Choi, Woo Gun Choi, Hack Ki Kim, Kyong Su Lee, Du Bong Lee
Department of Pediatrics, Catholic University Medical College, Seoul, Korea
중중 재생불량성 빈혈의 치료* -골수이식과 면역조절요법의 비교-
정대철, 최성동, 최우건, 김학기, 이경수, 이두봉
가톨릭의과대학 소아과학교실
Received: 13 August 1990   • Accepted: 12 October 1990
Twenty, six children younger than 15 years with severe aplastic anemia underwent either bone marrow transplantation or immunomodulation therapy (antilymphocyte globulin with cyclosporin A therapy). Six patients who had an HLA-identical sibling donor underwent bone marrow transplantation after conditioning with cyclophosphamide, procarbazine and antilymphocyte globulin. Twenty children who did not have an HLA-identical donor recieved antilymphocyte globulin and cyclosporin A. The results were as follows; 1) Hematologic responses: Complete response after transplant was showed five out of six (83.3%) and no response in one. In immunomodulation group, three out of twenty patients responded com- pletely (15%) and five were partially (25%). 2) Complications: In the complications according to the therapy, all patients who underwent transplantation showed acute graft versus host disease, in which two were chronic course, one died of rejection after 1 month, and two showed herpes zoster. In immunomodulation group, there were thrombocytopenia, hypertension, fever and serum sickness etc. 3) Causes of death: In bone marrow transplantation group, one patient who showed rejection after 1 month at transpint expired due to intracerebral hemorrhage. In immunomodulation therapy, seven out of twenty patients died. Among them, five were hemorrhage (71.4%) due to thrombocytopenia and two were infection. Therefore major cause of death was rejection in transplant and hemorrhage in immunomodulation group. Although this study is preliminary, our data suggest that bone marrow transplantation may be more useful therapeutic modality for the patient with severe aplastic anemia than immunomodulation therapy if there is HLA-identical sibling donor because of worst prognosis in this disease.
Key Words: Severe aplastic anemia, Bone marrow transplantation, Immunomodulation

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