Treatment of aplastic anemia with antilymphocyte globulin and methylprednisolone with or without cyclosporine
Article Abstract:
Aplastic anemia is a blood disorder resulting from the suppression of bone marrow function. Since the bone marrow is the source of blood cells, the disease leads to the progressive reduction or abnormalities in both white and red cells. Treatment of patients by bone marrow transplantation from donors who are immunologically compatible is effective. However, this is usually possible only for children whose siblings are compatible; therefore, other approaches are needed. One method that shows promise is antilymphocyte globulin, which contains antibodies against lymphocytes. This agent is known to promote the growth and development of hematopoietic cells (cells that make blood cells) under laboratory conditions. To compare results of treating patients with aplastic anemia with antilymphocyte globulin and methylprednisolone (another immunosuppressant drug), with or without cyclosporine (an immunosuppressant often used after organ transplantation), a multi-center study was carried out in Germany. Eighty-four patients who were not eligible for bone marrow transplantation were randomly assigned to receive either antilymphocyte globulin and methylprednisolone (control group, 41 patients), or those agents plus cyclosporine (cyclosporine group, 43 patients), for three months. Levels of red and white blood cells were measured three months after treatment began and at regular intervals thereafter. Results showed that 65 percent of the patients in the cyclosporine group responded to treatment by the end of three months, compared with 39 percent of control patients. Improvement was particularly marked for those with severe disease. Significant differences were also found six months after treatment; at 12 months, more patients in the cyclosporine group were in remission, but the differences were no longer statistically significant. Two years later, no differences in survival between the groups were seen (64 percent and 58 percent). The combination of antilymphocyte globulin, methylprednisolone, and cyclosporine is recommended for patients with aplastic anemia who are not eligible for bone marrow transplantation. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1991
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Immunosuppression in aplastic anemia - postponing the inevitable?
Article Abstract:
Suppression of the immune system is known to relieve the symptoms of patients suffering from aplastic anemia, a disorder of bone marrow. Since bone marrow is the site of production of many types of blood cells, the condition is associated with a deficit of virtually all blood cell types. One immunosuppressive agent that has been used to treat aplastic anemia is antilymphocyte globulin, which contains antibodies manufactured against lymphocytes (white blood cells). While one reason this substance is effective may be its ability to eliminate a group of suppressor T cells (a subclass of T cells, one component of the immune system) that attack the early forms of blood cells in anemic patients, other experiments have shown that eliminating these cells by other means does not produce the same therapeutic effect. Cyclosporine is an immunosuppressant with powerful effects on T cells; it has been used in combination with other drugs to treat aplastic anemia. The results of these studies are briefly discussed. A research article in the May 9, 1991 issue of The New England Journal of Medicine reports the effects of treating aplastic anemia patients with antilymphocyte globulin, methylprednisolone (an immunosuppressant), and cyclosporine. This regimen was particularly effective for patients with severe disease, although survival was not significantly improved for patients who received these drugs (64 percent) compared with those who received antilymphocyte globulin and methylprednisolone only (58 percent). Whether cyclosporine really improved the outcome for these patients needs careful evaluation. Bone marrow transplantation from an immunologically compatible sibling remains the preferred treatment for aplastic anemia patients younger than 20; for older patients, bone marrow transplantation becomes progressively more associated with complications and mortality. Patients who lack immunocompatible siblings (who constitute the majority of cases) must be treated with immunosuppressants; bone marrow transplantation using noncompatible donors is a last resort. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1991
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Host-specific interleukin-2-secreting donor T-cell precursors as predictors of acute graft-versus-host disease in bone marrow transplantation between HLA-identical siblings
Article Abstract:
Measuring host-specific interleukin-2-secreting T-cell precursors in donors before bone marrow transplantation can predict the incidence of acute graft-versus-host disease (GVHD) in recipients after transplantation. T-cells play an active role in the body's immune response. Acute graft-versus-host-disease occurs when incompatible donor cells attack the recipient cells and can be a life-threatening complication of bone marrow transplantation. A study of 16 patients and the siblings they were matched with found eight patients with severe acute GVHD all had donors with host-reactive T-cell precursor frequencies of greater than one per 100,000 before transplantation. The eight patients with mild GVHD had donors with frequencies of less than one per 100,000. These findings suggest patients at risk for severe GVHD can be identified beforehand and receive another form of treatment.
Publication Name: The New England Journal of Medicine
Subject: Health
ISSN: 0028-4793
Year: 1992
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