ATG/ALG联合环孢素A治疗老年重型再生障碍性贫血16例疗效及安全性评估

OBJECTIVE: To evaluate the efficacy and safety of intensive immunosupressive therapy (IST) with antithymocyte/antilymphocyte globulin plus cyclosporine A in the treatment of older patients (≥60 years) with severe aplastic anemia (SAA). METHODS: The hematologic response and safety of sixteen older SAA patients treated with IST regimen in our hospital were retrospectively analyzed, and the factors affecting response were also explored. RESULTS: A total of 16 older SAA patients were involved, the median age was 63.5 (60–79) years. Among them, 7 were VSAA and 9 were SAA; 9 patients received Rabbit anti-human thymocyte globulin (rATG), and 7 patients porcine anti-human lymphocyte globulin (pALG). Two patients died within 3 months after IST; at the 6 months after IST, 9 patients achieved hematology response and 5 patients had no response; overall response rate was 56.3%. Two (22%) of the 9 patients treated with rATG achieved hematology response; However, all 7 patients (100.0%) treated with pALG achieved hematology response. rATG/pALG associated adverse reactions were mild and easily managed. CONCLUSION: The older patients with SAA could still benefit from IST consisting of standard dose rATG/pALG with CsA, and the patients with VSAA had worse prognosis, pALG was inferior to rATG as a first treatment for SAA.