title: Survival after immunosuppressive therapy in children with aplastic anemia.
abstract: OBJECTIVE
  To determine the survival of children =18 y, treated with immunosuppressive therapy (IST) using equine antithymocyte globulin (e-ATG) and cyclosporine (CsA).
  
  
  METHODS
  Prospective data entry as per a specified format.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  From January 1998 to December 2009, 40 children were diagnosed with acquired aplastic anemia; 33 patients, who received IST, were analyzed. 31 children (94%) received one course of e-ATG and CsA. 2 patients (6%) received two courses of ATG.
  
  
  METHODS
  Immunosuppressive therapy using equine ATG and cyclosporine.
  
  
  METHODS
  Overall response and overall survival.
  
  
  RESULTS
  The overall response (complete response + partial response) to IST at 6 months was 87.9%. 8 (24.2%) patients achieved CR, 21 (63.6%) patients had PR and 4 (12.1%) patients did not respond to IST. Median follow-up was 24 (6-102) months. Overall survival at 24 months was 90%, with an actual survival of 85.4% at 5 years. Seventeen patients (51.5%) received G-CSF for a median duration of 32 (23-64) days. The patients who received G-CSF had fewer infectious complications (P=0.002), but G-CSF administration did not influence survival/ outcome. No patient developed myelodysplastic syndrome or acute leukemia.
  
  
  CONCLUSIONS
  The survival of patients who respond to IST is excellent. Also, G-CSF reduces the infectious complications without conferring any survival advantage.
authors.affiliation: Department of Medicine, Armed Forces Medical College, Pune, Maharashtra, India. profvelunair@gmail.com
authors.forename: Velu
authors.initials: V
authors.lastname: Nair
authors.forename: Vishal
authors.initials: V
authors.lastname: Sondhi
authors.forename: Ajay
authors.initials: A
authors.lastname: Sharma
authors.forename: Satyaranjan
authors.initials: S
authors.lastname: Das
authors.forename: Sanjeevan
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000741:Anemia, Aplastic / Q000188:drug therapy* / Q000453:epidemiology; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007194:India / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D016179:Granulocyte Colony-Stimulating Factor; D016572:Cyclosporine