title: Immunomodulation therapy for severe aplastic anemia--ALG versus ALG plus cyclosporin A.
abstract: Immunosuppressive treatment of aplastic anemia has been increasingly used as an alternative treatment to bone marrow transplantation. In this study, the additive effect of Cyclosporin A (CSA) (5mg/kg/day, at least 3 months) for maintenance of immunosuppression after antilymphocyte globulin (ALG) therapy (40mg/kg/day for 4 days) was compared to the previous ALG alone treatment (15mg/kg/day for 10 days). A high dose of methylprednisolone (20mg/kg/day for 5 days and 10mg/kg/day for 5 days) to the ALG group and a low dose of methylprednisolone (2mg/kg/day for 5 days) to the ALG plus CSA group were administered simultaneously. The results were as follows: 1) Sixteen (69.6%) out of twenty-three patients treated with ALG plus Cyclosporin A showed higher responses (CR: 48%, PR: 22%). On the contrary, nine out of nineteen in the ALG group showed lower responses (CR: 21%, PR: 26%). 2) Our data showed a tendency that male patients in age ranging from sixteen to thirty years showed an excellent response to ALG therapy (12/23: 52.2%). 3) The ALG plus CSA group revealed a faster response compared to the ALG alone group (15/16 within 6 months). 4) We speculate that ALG plus CSA therapy might be the treatment of choice for patients with a moderate degree of aplastic anemia. 5) Adding CSA to ALG increased the chance of infection, such as those with URI-like symptoms, but it did not affect the mortality rate. Our data suggest that the ALG plus CSA regimen may be a more useful therapeutic modality for patients with severe aplastic anemia who cannot be candidates for bone marrow transplantation and a randomized multicenter study is needed for confirmation of our preliminary study.
authors.forename: C W
authors.initials: CW
authors.lastname: Park
authors.forename: C H
authors.initials: CH
authors.lastname: Han
authors.forename: C C
authors.initials: CC
authors.lastname: Kim
authors.forename: D J
authors.initials: DJ
authors.lastname: Kim
authors.forename: H K
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000741:Anemia, Aplastic / Q000628:therapy*; D000961:Antilymphocyte Serum / Q000008:administration & dosage* / Q000627:therapeutic use; D003524:Cyclosporins / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D012737:Sex Factors; D013997:Time Factors
chemical_list: D000961:Antilymphocyte Serum; D003524:Cyclosporins; D008775:Methylprednisolone