Use of Androgens in Acquired Aplastic Anaemia

Abstract

124 adult patients with acquired aplastic anaemia (A.A.) were studied. 54 presented as severe A.A. (mean survival of the whole group, 2.7 months and in those who died, 2.5 months; mortality 88.8%) while 70 were mild (mean survival of the whole group, 27.2 months and in those who died, 22.7 months; mortality, 28.5%). Sixty-four did not live long enough to have adequate therapeutic trials or developed severe hepatic failure which made it impossible to continue treatment. The effectiveness of 78 therapeutic periods of treatment in the 60 evaluable cases was analyzed as to aetiology and severity. A response was obtained in 31 (40%), of which 24 were with oxymethalone; 17 showed improvement after 6 months of treatment. No conclusions could be drawn as to the effectiveness of methalone, cyclophosphamide and prednisone because of the limited number of treatments. In severe A.A. only one of 13 treatments was effective, whereas 30 of the 65 used in mild A.A. gave a response. Oxymethalone was used in 23 out of 41 (56%). The aetiology, sex and age appeared to have no influence on the response of the 60 patients analyzed. The only factor which appears useful for prognosis as to the effectiveness of treatment is the severity of the case.

Aplastic Anemia before Bone Marrow Transplantation and Antilymphocyte Globulin

“…The same is true for some [41, 42], but not all [43]studies testing the additional effect of androgens to IST. However, improved survival as compared to historical controls in some series including nonsevere cases [44, 45]and the observation of androgen dependency in single cases [36, 46]suggest that androgens can lead to some improvement in a minority of less severe [47]cases. Based on these observations, a trial of mesterelon or oxymethenolone is still justified in patients with nonsevere aplastic anemia or with partial remission, but insufficient recovery, in order to try and improve their quality of life compromised by anemia, or to lower the frequency of red cell transfusions.…”

Low Doses of High-Potency Antithymocyte Globulin (ATG) in Severe Aplastic Anemia: Experience with the Mexican ATG

“…The response and sur vival of patients with SAA treated with BMT + ATG, BMT alone or ATG alone does not seem to be very different [4], The role of androgens alone in the treat ment of SAA has been ruled out and is significantly lower than that of ATG [5]. SAA affects 5-30 new pa tients per million per year in Europe and a higher in cidence has been reported in Japan, China and Mex ico [6][7][8][9][10], BMT programs are expensive and, up to now, there is no one working regularly in our country where few BMTs have been performed [11], Even though the costs of the ATG infusion are lower than that of BMT, ATG is expensive in our country: only 10-15% of patients with SAA in Mexico can afford the costs of the ATG treatment. In an effort to make affordable the treatment for most patients with SAA in Mexico, the Agrupación Mexicana para el Estudio de la Hematología AC (Mexican Society of Hematol ogy), through its Grupo Cooperativo de Eritropatías y Hemopoyesis (Mexican Cooperative Group for the Study of Erythropathies and Hemopoiesis) started a program to produce a batch of equine ATG to be em ployed in patients with SAA.…”