Immunosupressive therapy of aplastic anemia patients: successes and failures (single center experiment 2007–2016)
- Authors: Mikhaylova E.A.1, Fidarova Z.T.1, Abramova A.V.1, Luchkin A.V.1, Troitskaya V.V.1, Dvirnyk V.N.1, Galtseva I.V.1, Kliasova G.A.1, Kovrigina A.M.1, Kulikov S.M.1, Chabaeva Y.А.1, Parovichnikova E.N.1, Savchenko V.G.1, Obukhova T.N.1
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Affiliations:
- National Research Center for Hematology
- Issue: Vol 92, No 7 (2020)
- Pages: 4-9
- Section: Editorial
- URL: https://journals.rcsi.science/0040-3660/article/view/43117
- DOI: https://doi.org/10.26442/00403660.2020.07.000756
- ID: 43117
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Abstract
Treatment programs for patients with acquired aplastic anemia include two main therapeutic options: allogeneic bone marrow transplantation and combined immunosuppressive therapy (IST). However, combined IST remains the method of choice for most adult AA patients. This study included 120 AA patients who received IST at the National Research Center for Hematology in 2007–2016. The analysis was applied to 120 patients. Median age was 25 (17–65) years, M/F: 66/54, SAA/NSAA: 66%/34%. Effectiveness of IST was carried out in 120 patients with AA. This group did not include 8 SAA patients who died during the first 3 months from the start of treatment from severe infectious complications (early deaths – 6.2%) and 2 AA patients who dropped out of surveillance. The observation time was 55 (6–120) months. Paroxysmal nocturnal hemoglobinuria (PNH clone) was detected in 67% of AA patients. The median PNH clone size (granulocytes) was 2.5 (0.01–99.5)%. The treatment was according to the classical protocol of combined IST: horse antithymocytic globulin and cyclosporin A. Most of patients (87%) responded to combined immunosuppressive therapy. To achieve a positive response, it was sufficient to conduct one course of ATG to 64% of patients, two courses of ATG – 24% of patients and 2% of patients responded only after the third course of ATG. A positive response after the first course was obtained in 64% of patients included in the analysis. Most of the responding patients (93%) achieve a positive response after 3–6 months from the start of treatment. Therefore, the 3rd–6th months after the first course of ATG in the absence of an answer to the first line of therapy can be considered the optimal time for the second course of ATG. This tactic allows to get an answer in another 58% of patients who did not respond to the first course of ATG. The probability of an overall 10-year survival rate was 90% (95% confidence interval 83.6–96.2).
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##article.viewOnOriginalSite##About the authors
E. A. Mikhaylova
National Research Center for Hematology
Author for correspondence.
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0002-2449-2682
д.м.н., проф., вед науч. сотр. отд-ния высокодозной интенсивной химиотерапии гемобластозов и депрессий кроветворения с круглосуточным стационаром
Russian Federation, MoscowZ. T. Fidarova
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0003-0934-6094
к.м.н., зав. отд-нием химиотерапии гемобластозов и депрессий кроветворения с дневным стационаром
Russian Federation, MoscowA. V. Abramova
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0002-8113-6115
врач отд-ния высокодозной интенсивной химиотерапии гемобластозов и депрессий кроветворения с круглосуточным стационаром
Russian Federation, MoscowA. V. Luchkin
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0002-4400-4711
врач отд-ния высокодозной интенсивной химиотерапии гемобластозов и депрессий кроветворения с круглосуточным стационаром
Russian Federation, MoscowV. V. Troitskaya
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0002-4827-8947
к.м.н., зав. отд-нием интенсивной высокодозной химиотерапии гемобластозов и депрессий кроветворения с круглосуточным стационаром
Russian Federation, MoscowV. N. Dvirnyk
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0002-9877-0796
к.м.н., зав. лаб. клинической лабораторной диагностики
Russian Federation, MoscowI. V. Galtseva
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0002-8490-6066
к.м.н., зав. лаб. иммунофенотипирования клеток крови и костного мозга
Russian Federation, MoscowG. A. Kliasova
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0001-5973-5763
д.м.н., проф., зав. лаб. клинической бактериологии, микологии и антибиотической терапии
Russian Federation, MoscowA. M. Kovrigina
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0002-1082-8659
д.б.н., зав. патологоанатомическим отд-нием
Russian Federation, MoscowS. M. Kulikov
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
зав. информационно-техническим отд.
Russian Federation, MoscowYu. А. Chabaeva
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0001-8044-598X
специалист информационно-технического отд.
Russian Federation, MoscowE. N. Parovichnikova
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0001-6177-3566
д.м.н., проф., рук. отд. химиотерапии гемобластозов, депрессий кроветворения и ТКМ
Russian Federation, MoscowV. G. Savchenko
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0001-8188-5557
акад. РАН, д.м.н., проф., ген. дир.
Russian Federation, MoscowT. N. Obukhova
National Research Center for Hematology
Email: mikhaylova.e@blood.ru
ORCID iD: 0000-0003-1613-652X
зав. кариологической лаб.
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