Aplastic anemia medical therapy: Difference between revisions
(/* Specific Treatment of Aplastic Anaemia: Immunosuppressive Therapy: ATG and Ciclosporin {{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 apl...) |
(/* Specific Treatment of Aplastic Anaemia: Immunosuppressive Therapy: ATG and Ciclosporin {{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 apl...) |
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* 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. | * 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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==Specific Treatment of Aplastic Anaemia: Immunosuppressive Therapy: ATG and Ciclosporin <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| | |||
===Immunosuppressive Therapy: ATG and Ciclosporin=== | |||
* [[Immunosuppressive therapy]] is recommended for: | |||
** patients with non-severe [[aplastic anaemia]] who are transfusion dependent | |||
** patients with severe or very severe disease who are >40 years old, and | |||
** younger patients with severe or very severe disease who do not have an HLA-identical sibling donor. | |||
* [[ATG]] is a powerful [[immunosuppressive]] drug and its use in severely [[neutropenic]] patients requires very careful monitoring, prophylaxis and treatment of fevers, and adequate (and sometimes intensive) platelet transfusional support. | |||
* ATG must only be given as an in-patient: | |||
* [[Ciclosporin]] should be continued for at least 12 months after achieving maximal haematological response, followed by a very slow tapering, to reduce the risk of relapse. | |||
}} | }} | ||
Revision as of 15:32, 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: Human Leucocyte Antigen (HLA)-identical Sibling Donor Transplantation [1] (DONOT EDIT)
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Human Leucocyte Antigen (HLA)-identical Sibling Donor Transplantation
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Specific Treatment of Aplastic Anaemia: Immunosuppressive Therapy: ATG and Ciclosporin [1] (DONOT EDIT)
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Immunosuppressive Therapy: ATG and Ciclosporin
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Specific Treatment of Aplastic Anaemia: Immunosuppressive Therapy: ATG and Ciclosporin [1] (DONOT EDIT)
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Immunosuppressive Therapy: ATG and Ciclosporin
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References
- ↑ 1.0 1.1 1.2 1.3 1.4 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.