Clinical Study On Short-Term Effect Of ATG Plus CSA Therapy In Treatment Of Severe Aplastic Anemia

Objective:Severe Aplastic Anemia(SAA) is one of lethal diseases. For the SAA patients≥40 years of age, and SAA patients<40 years who lack an HLA-identical sibling donor, ATG plus CSA therapy is one of immuno-suppressive therapies and suggested as first-line therapy. We collected 12 SAA patients'clinical data and evaluated their clinical effect in order to find the clinical factors that may contribute to different outcomes of this regimen. Besides,we took the side effects in concern so as to find the way to prevent or treat them.Methods:From December 2009 to January 2011, there were 12 SAA/VSAA patients were treated by ATG plus CSA therapy in our hospital, we chose them as the objects of our study. We collected their clinical data such as age, sex, type of aplastic anemia, the course of disease, HBV infectious history etc, and we monitered the change of their symptom, the curve of peripheral blood cell counts, and the incidence of different side effects.Results:12 patients were included, among them there are 10 patients can be assessed about the treatment effect:4 patients got complete response,4 got partial response,1 patient has no response,1 patient died after ATG treatment, the overall effective rate was 80.0%. Individual data analysis shows that the effective rate was not related with age, sex, type of disease, reticulocyte counts, course of disease, and severe infection, infectious history (P>0.05).The patients who got response to this therapy had their blood cells counts increased after 1-2 months:white blood cell counts and neutrophil counts increased first, while hemoglobin and platelet increased at least 3 mouths after ATG treatment. As we see, the most common side effect was varying degrees of acute allergic reaction and serum disease (75%), the next was infection (58.3%), all the side effects were in control, so all the patients finished taking whole dose of ATG.Conclusions:For the SAA/VSAA patients who can not receive homatopoietic stem cell transplantation, ATG plus CSA is a standard therapy. In this study, we figure out the short-term response rate was 80%.After ATG treatment, white blood cell counts and neutrophil counts recovered first, while hemoglobin and platelet recovered slowly. We did not find that the response rate was related with age, sex, reticulocyte counts, course of disease, and bad infection, HBV infectious history.With the glucocorticoid and supportive therapy, we can provent or treat acute allergic reaction and serum disease. Infection can often be seen after ATG treatment, so the patients treated with ATG should stay in laminar flow ward to avoid infection that is normally can be cured.