Aplastic anemia medical therapy: Difference between revisions
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{{Aplastic anemia}} | {{Aplastic anemia}} | ||
'''Editor-In-Chief:''' Aric Hall, M.D., Beth Israel Deaconess Medical Center, Boston, MA [mailto:achall@bidmc.harvard.edu] | '''Editor-In-Chief:''' Aric Hall, M.D., Beth Israel Deaconess Medical Center, Boston, MA [mailto:achall@bidmc.harvard.edu] | ||
==Overview== | ==Overview== | ||
Medical therapy of aplastic anemia often includes a short course of [[anti-thymocyte globulin]] (ATG or [[anti-lymphocyte globulin]]) and several months of treatment with [[cyclosporin]] to modulate the [[immune system]]. Mild [[chemotherapy]] with agents such as [[cyclophosphamide]] and [[vincristine]] may also be effective. [[Antibody|Antibodies]] therapy, such as ATG, targets T-cells, which are believed to attack the bone marrow. [[Steroids]] are generally ineffective. | Medical therapy of aplastic anemia often includes a short course of [[anti-thymocyte globulin]] (ATG or [[anti-lymphocyte globulin]]) and several months of treatment with [[cyclosporin]] to modulate the [[immune system]]. Mild [[chemotherapy]] with agents such as [[cyclophosphamide]] and [[vincristine]] may also be effective. [[Antibody|Antibodies]] therapy, such as ATG, targets T-cells, which are believed to attack the bone marrow. [[Steroids]] are generally ineffective. | ||
==Medical Therapy== | ==Medical Therapy== | ||
==Supportive Care in treatment of aplastic anemia <ref name="pmid19673883">{{cite journal| author=Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC et al.| title=Guidelines for the diagnosis and management of aplastic anaemia. | journal=Br J Haematol | year= 2009 | volume= 147 | issue= 1 | pages= 43-70 | pmid=19673883 | doi=10.1111/j.1365-2141.2009.07842.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19673883 }} </ref> (DONOT EDIT)== | ==Supportive Care in treatment of aplastic anemia <ref name="pmid19673883">{{cite journal| author=Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC et al.| title=Guidelines for the diagnosis and management of aplastic anaemia. | journal=Br J Haematol | year= 2009 | volume= 147 | issue= 1 | pages= 43-70 | pmid=19673883 | doi=10.1111/j.1365-2141.2009.07842.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19673883 }} </ref> (DONOT EDIT)== | ||
{{cquote| | {{cquote| | ||
===Supportive Care=== | ===Supportive Care=== | ||
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* Iron chelation therapy should be considered when the serum ferritin is >1000 µg/L. | * Iron chelation therapy should be considered when the serum ferritin is >1000 µg/L. | ||
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==Specific Treatment of Aplastic Anaemia: General Comments <ref name="pmid19673883">{{cite journal| author=Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC et al.| title=Guidelines for the diagnosis and management of aplastic anaemia. | journal=Br J Haematol | year= 2009 | volume= 147 | issue= 1 | pages= 43-70 | pmid=19673883 | doi=10.1111/j.1365-2141.2009.07842.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19673883 }} </ref> (DONOT EDIT)== | ==Specific Treatment of Aplastic Anaemia: General Comments <ref name="pmid19673883">{{cite journal| author=Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC et al.| title=Guidelines for the diagnosis and management of aplastic anaemia. | journal=Br J Haematol | year= 2009 | volume= 147 | issue= 1 | pages= 43-70 | pmid=19673883 | doi=10.1111/j.1365-2141.2009.07842.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19673883 }} </ref> (DONOT EDIT)== | ||
{{cquote| | {{cquote| | ||
===General Comments=== | ===General Comments=== | ||
* Infection or uncontrolled [[bleeding]] should be treated first before giving [[immunosuppressive]] therapy. | * Infection or uncontrolled [[bleeding]] should be treated first before giving [[immunosuppressive]] therapy. | ||
* This also applies to patients scheduled for [[bone marrow transplant]] (BMT), although it may sometimes be necessary to proceed straight to BMT in the presence of severe infection as a BMT may offer the best chance of early neutrophil recovery. | * This also applies to patients scheduled for [[bone marrow transplant]] (BMT), although it may sometimes be necessary to proceed straight to BMT in the presence of severe infection as a BMT may offer the best chance of early neutrophil recovery. | ||
Revision as of 15:09, 23 September 2012
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Editor-In-Chief: Aric Hall, M.D., Beth Israel Deaconess Medical Center, Boston, MA [1]
Overview
Medical therapy of aplastic anemia often includes a short course of anti-thymocyte globulin (ATG or anti-lymphocyte globulin) and several months of treatment with cyclosporin to modulate the immune system. Mild chemotherapy with agents such as cyclophosphamide and vincristine may also be effective. Antibodies therapy, such as ATG, targets T-cells, which are believed to attack the bone marrow. Steroids are generally ineffective.
Medical Therapy
Supportive Care in treatment of aplastic anemia [1] (DONOT EDIT)
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Supportive Care
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Specific Treatment of Aplastic Anaemia: General Comments [1] (DONOT EDIT)
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General Comments
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Specific Treatment of Aplastic Anaemia: General Comments [1] (DONOT EDIT)
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General CommentsHuman Leucocyte Antigen (HLA)-identical Sibling Donor Transplantation Allogeneic BMT from an HLA-identical sibling donor is the initial treatment of choice for newly diagnosed patients if they have severe or very severe aplastic anaemia, are <40 years old, and have an HLA-compatible sibling donor. Patients with Fanconi anaemia and other types of inherited aplastic anaemia need special consideration and should not follow recommendations made in this guideline. There is no indication for using irradiation-based conditioning regimens for patients undergoing HLA-identical sibling BMT for aplastic anaemia. The recommended source of stem cells for transplantation in aplastic anaemia is bone marrow. Fertility is well preserved after high dose cyclophosphamide conditioning in BMT for aplastic anaemia, and patients should be given appropriate contraceptive advice to prevent unwanted pregnancy. Until longer term data is available in patients receiving fludarabine-based regimens, cryopreservation of sperm and oocytes should be planned.
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References
- ↑ 1.0 1.1 1.2 Marsh JC, Ball SE, Cavenagh J, Darbyshire P, Dokal I, Gordon-Smith EC; et al. (2009). "Guidelines for the diagnosis and management of aplastic anaemia". Br J Haematol. 147 (1): 43–70. doi:10.1111/j.1365-2141.2009.07842.x. PMID 19673883.