Treatment and Prognosis in Aplastic Anæmia

The effect of conservative treatment of aplastic anaemia was evaluated retrospectively in 40 patients. No significant beneficial effect was provided by long-term high-dose oxymethalone in 20 patients or by metenolone, adrenostenolone, or testosterone in 14 patients. Splenectomy gave no improvement in the majority of cases, although in some it decreased the transfusion requirement. Immunosuppressive treatment was successful in 1 patient with a positive LE phenomenon. Until a specific treatment becomes available, the possibility offered by alternative treatment, e.g. bone marrow transplantation, in cases with poor prognostic parameters should be considered

Section: Discussionsupporting

confidence: 92%

Acquired Aplastic Anaemia in Adults

Hl¹,

Ca²,

Hf³

et al. 1977

“…This finding, assumed to reflect two distinct disease categories, has led to attempts to subclassify patients at the begin of their disease by means of clinical fac tors, initial blood studies, or a combination of both. A rapid onset of disease and the presence of hemor rhagic symptoms is associated with diminished sur vival [4,5], as are low initial counts of neutrophils [4,6,7], platelets [4,6] or reticulocytes [2,4,6,8,9]. In our hands, an initial analysis of numbers of reticulo cytes proved impractical due to considerable day-today fluctuations.…”

Section: Discussionmentioning

confidence: 91%

Aplastic Anemia: Assessment of Myeloid Progenitor Cells in the Bone Marrow and Blood Provides Prognostic Information

Hinterberger¹,

Geißler²,

Fischer³

et al. 1985

15 patients with aplastic anemia were prospectively followed after having measurements of myeloid progenitor cells in bone marrow and blood. Treatment included androgens, low or high dose steroids and standardized supportive care. The median length of survival was 5.8 months. When patients were grouped according to the numbers of myeloid progenitor cells present in their blood and bone marrow, we found that the survival length of aplastic patients with higher progenitor cell numbers was prolonged when compared to that of patients with lower numbers of these cells. The prognostic information obtained from such in vitro cultures was particularly indicative when the patients were grouped according to ‘growth’ and ‘no growth’: the absence of colony-forming myeloid stem cells was associated with survival times significantly shorter than those of patients whose cells maintained their colony-forming capacity. Besides initial numbers of myeloid progenitor cells, only initial numbers of granulocytes were related to survival length. Thus, the measurement of myeloid progenitor cells in bone marrow and blood can be of prognostic value in patients with aplastic anemia.

“…Despite the lack of evidence of engraftments, a pure coincidence between the onset of improvement and the bone marrow graft appears highly unlikely. All three patients had pro found granulocytopenia and thrombocytopenia with major haemorrhagic and infectious complications, which are usually associated with a poor prognosis [1,2,4,5]. All had been treated with androgens, the best avail able supportive care for many months, two without improvement, one with only temporary benefit.…”

Section: Discussionmentioning

confidence: 99%

“…Acquired aplastic anaemia (AA) is a poorly understood entity with a bad prognosis [1][2][3][4][5][6]. Several aetiological factors may be responsible for the disorder, in particular failure of the haemopoetic stem cell, disturb ance of the bone marrow matrix, and potentially a disturbance in the hu moral factors which regulate haemopoesis [6].…”

mentioning

confidence: 99%

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Autologous Marrow Reconstitutions in Severe Aplastic Anaemia after ALG Pretreatment and HL-A Semi-Incompatible Bone Marrow Cell Transfusion

Jeannet¹,

Speck²,

Rubinstein³

et al. 1976

Three consecutive patients considered to have end-stage acquired aplastic anaemia were given 100–160 mg/kg antilymphocyte globulin (ALG) i.v. followed by an infusion of 2–3.8 × 10⁸ nucleated marrow cells/kg i.v. from HL-A one haplotype-identical, MLC-positive family donors. All patients showed autologous marrow reconstitutions lasting now 2–3¹/₂ years. No clear-cut evidence of marrow engraftment could be established and no graft-versus-host disease was seen. It is assumed that these patients had some normal pluripotent haemopoetic stem cells which proved to be able of endoreduplication and of going into cycle after ALG conditioning and allogeneic marrow transfusion.