Treatment of aplastic anemia: Experience of Ibn-i Sina Hospital

Treatment of aplastic anemia can be with either immunosuppressive therapy (IST) or allogeneic stem cell transplantation (ASCT). The optimal conditions when to perform IST or ASCT are controversial. In the present report, the results of 30 patients who were given IST and 15 patients who underwent ASCT are documented. All patients having received ASCT but 15 of the 30 patients having received IST had severe, and the remaining 15 patients had nonsevere aplastic anemia. Twentyfive patients received combined IST (Cyclosporine A, Antithymocyte globulin, Methyl Prednisolon). Only 5 patients received cyclosporine A alone. Twenty patients responded to the IST (74%); 10 (37%) with complete and 10 (37%) with partial remission, at the end of 6 months. Fifteen patients with HLA compatible sibling donors received ASCT (12 bone marrow, 3 peripheral stem cell). Six (40%) of the 15 patients are still alive at the end of long term follow up (11 days- 8 years). Cyclophosphamide alone or combined with total body (or lymphoid) irradiation or antithymocyte globulin were used as conditioning regimens. Total body (or lymphoid) irradiation which had been used in the earlier transplantations was associated with increased mortality rate. In our department IST is prefered to stem cell transplantation except for very young patients (<18 years) with severe aplastic anemia and for treatment failure. We concluded that the unsatisfying results with ASCT depended on both the content of the conditioning regimen and the heavy transfusion history.