Treatment

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Supportive Care

1. Avoid exposure to hazardous drugs and toxins.

2. The risk of serious bleeding and symptomatic anemia must be balanced against the risk of transfusion sensitization and iron overload. Unless symptomatic,

Table 6-18. Recommendations for Treatment of Aplastic Anemia

1. Moderate aplastic anemia:

Observe with close follow-up and supportive care

If the patient develops:

a. Severe aplastic anemia and/or b. Severe thrombocytopenia with significant bleeding and/or c. Chronic anemia requiring transfusion treatments and/or d. Serious infections

Then treat with the same recommended therapy for severe aplastic anemia

2. Severe aplastic anemia:

Allogeneic bone marrow transplantation when HLA-matched sibling donor available

In the absence of an HLA-matched sibling marrow donor:

Treat the patient with ATG, cyclosporine A (CSA), methylprednisolone, and growth factors such as G-CSF or GM-CSF

If no response or waning of response and recurrence of severe aplastic anemia, a second course of immunosuppressive therapy is not recommended since the use of a second course is controversial. The following is recommended:

a. HLA-matched (genotypic matched preferred) unrelated bone marrow, peripheral blood or umbilical cord blood transplant if a suitable donor is available. In the absence of availability of such a donor an HLA-mismatched (1 antigen) bone marrow or mismatched (1-2 antigens) umbilical cord transplant is recommended b. High-dose cyclophosphamide and cyclosporine therapy without stem cell transplant is carried out in some institutions

Notes.Partial response: absence of infections and transfusion dependency and sustained increase in all cell counts as follows: reticulocyte count, >20,000/mm3; platelet count, >20,000/mm3; absolute neutrophil count, >500/mm3. Complete response: Normal counts. Partial response and complete response are considered as responses for the evaluation of the success of immunosuppressive therapy.

Table 6-19. Prognostic Factors in Acquired Aplastic Anemia

Factor

Favorable

Unfavorable

Granulocyte count

>500/mm3

<500/mm3 (<200/mm3 is more

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