THERAPY OF SEVERE APLASTIC-ANEMIA WITH ANTI-HUMAN THYMOCYTE GLOBULIN AND ANDROGENS - THE EFFECT OF HLA-HAPLOIDENTICAL MARROW INFUSION

  • 1 January 1984
    • journal article
    • research article
    • Vol. 63  (2) , 342-348
Abstract
Patients (54) with severe aplastic anemia were treated with horse anti-human thymocyte globulin (ATG) and androgens. Of these patients, 30 also received an infusion of HLA-haploidentical marrow cells. Only those patients having evidence of hematologic recovery within 3 mo. after ATG therapy were considered responders to the immunosuppressive regimen. Of 53 patients evaluable for response, 21 had complete or partial responses and 7 had minimal improvement by defined criteria. The remaining patients did not respond or died. Factors correlated with response to therapy included a short duration of aplasia and a high admission granulocyte count. A total of 36 patients (66.7%) are surviving between 18 and 43 mo., and 18 died. Deaths were due to hemorrhage and/or infection. Short duration of aplasia and high granulocyte counts also correlated with survival, as did younger age. Four patients with complete or partial responses had a recurrence of severe aplasia 6-17 mo. after their 1st course of ATG. Of these patients, 3 were retreated with ATG (and oxymetholone in 2 cases). All 3 had 2nd responses to therapy, but 2 of the 3 had 2nd relapses. The 4th patient responded to oxymetholone alone, but died after a 2nd relapse. Mismatched marrow infusion had no effect on the incidence of response or survival.