Management of aplastic anemia after failure of frontline immunosuppression.

Management of aplastic anemia after failure of frontline immunosuppression. Expert Rev Hematol. 2019 Jul 17;: Authors: Pierri F, Dufour C Abstract Introduction: About 60% of aplastic anemia (AA) patients are in need of further treatment after front line standard immunosuppressive therapy (IST). This along with the prolonged survival of AA subjects who do not respond to or relapse after this treatment makes management of these patients a rising and very challenging issue. Areas Covered: Literature research, carried out from the most commonly used data bases, included the following key words: aplastic anemia, immunosuppressive treatment, Anti Thymocyte Globuline, Ciclosporine A, refractory aplastic anemia, relapsing aplastic anemia, haematopietic stem cell transplantation including haploidentical and cord blood transplantations thrombopoietin mimetics, supportive treatment, chelation and infections. Studies on treatment of aplastic anemia with different levels of evidence were included. Top level of evidence studies (metanalyses and randomized prospective controlled trials) were a minority because severe AA, particularly in the subset of patients who fail upfront IST, is an extremely rare disease. Guidelines from National Societies and review articles were also included. Expert Opinion: The most commonly used treatments after failure of upfront immunosuppression are hematopoietic stem cell transplantation, a second course of immunosupp...
Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research