Survival After Immunosuppressive Therapy in Children with Aplastic Anemia | Aplastic Anemia and MDS International Foundation

Survival After Immunosuppressive Therapy in Children with Aplastic Anemia

Journal Title: 
Indian Pediatr
Author(s): 
Nair V, Sondhi V, Sharma A, Das S, Sharma S
Primary Author: 
Nair V
Original Publication Date: 
Sunday, October 30, 2011

OBJECTIVE:

To determine the survival of children ?18y, treated with immunosuppresive therapy (IST) using equine antithymocyte globulin (e-ATG) and cyclosporine(CsA).
DESIGN:

Prospective data entry as per a specified format.
SETTING:

Tertiary care hospital.
PATIENTS:

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.
INTERVENTION:

Immunosuppressive therapy using equine ATG and cyclosporine.
MAIN OUTCOME MEASURES:

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 acturial 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.

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