How I treat acquired aplastic anemia

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How I treat acquired aplastic anemia by Andrea Bacigalupo Blood Volume 129(11):1428-1436 March 16, 2017 ©2017 by American Society of Hematology

Diagnostic procedures in patients with pancytopenia. Diagnostic procedures in patients with pancytopenia. ATG, antithymocyte globulin; BM, bone marrow; CsA, cyclosporine A; DEB, diepoxybutane; FA, Fanconi’s anemia; FISH, fluorescent in situ hybridization; GPI, glycosyl phosphatidyl inositol; MDS, myelodysplastic syndrome. Andrea Bacigalupo Blood 2017;129:1428-1436 ©2017 by American Society of Hematology

Treatment strategy in patients with acquired aplastic anemia. Treatment strategy in patients with acquired aplastic anemia. Patients are stratified according to whether or not they have an HLA-identical sibling. In young patients (<40 years) with a matched donor, allogeneic BMT is first-line therapy. In patients older than 40 years, and for patients without a matched sibling, ATG+CsA should be first-line therapy. In selected children with very severe disease, an unrelated donor (UD) graft may be considered first-line therapy (dashed arrow). In patients aged 0 to 60 years, nonresponders (no resp) to ATG have several choices, depending on the performance status of the patient, the availability of an HLA-matched UD, and patient age. The options are an UD BMT, a second course of IST (ATG+CsA), or an alternative donor transplant (Alt Donor Tx, indicating haploidentical transplants or cord blood [CB] transplants). At older than 60 years of age, medical treatment is preferable over BMT. d+120 = day +120; EPAG, eltrombopag; HLA = Sib, HLA-identical sibling; Sib BMT, identical sibling transplantation; UD BMT, unrelated donor BMT. Andrea Bacigalupo Blood 2017;129:1428-1436 ©2017 by American Society of Hematology

A strong age effect in patients with aplastic anemia, after transplantation from an HLA identical sibling. A strong age effect in patients with aplastic anemia, after transplantation from an HLA identical sibling. Data from the EBMT registry. Andrea Bacigalupo Blood 2017;129:1428-1436 ©2017 by American Society of Hematology

The age effect in UD transplants: best outcome is seen for very young patients, for whom first-line UD BMT may be considered. The age effect in UD transplants: best outcome is seen for very young patients, for whom first-line UD BMT may be considered. Data from the EBMT registry. Andrea Bacigalupo Blood 2017;129:1428-1436 ©2017 by American Society of Hematology

The age effect in patients receiving first-line IST The age effect in patients receiving first-line IST. Data from the EBMT registry. The age effect in patients receiving first-line IST. Data from the EBMT registry. Andrea Bacigalupo Blood 2017;129:1428-1436 ©2017 by American Society of Hematology