STUDY OF COMPARING RESPONSE TO TREATMENT WITH CYCLOSPORINE-A (CSA) ALONE VERSUS THE COMBINATION OF ANTITHYMOCYTE GLOBULIN (ATG) AND CYCLOSPORINE-A IN PATIENTS WITH APLASTIC ANEMIA
*Mallikarjuna Shetty, Dr Anukonda Moti Venkata Raja Narendra and Nageswar Rao Modugu
Introduction: Aplastic anemia (AA) is a syndrome characterized by peripheral pancytopenia with hypocellular marrow. Acquired idiopathic aplastic anemia is the most common variety, and its treated with cyclosporine-A, or Antithymocytic globulin or with Bone marrow transplantation. Aim: Study of comparing response to treatment with CSA alone versus the combination of ATG + CSA in aplastic anemia patients. Materials and Methods: This study was a prospective randomized study, conducted after getting approval from Institution ethical committee and conducted over 18 months. All patients underwent a detailed clinical examination and laboratory investigations. Diagnosed patients of acquired idiopathic aplastic anemia without active infection, otherwise not eligible for bone marrow transplantation were recruited. Patients were randomized to receive either CSA alone or the combination of ATG and CSA according to their choice. Assessment of response to therapy was made at the end of 3 months. Observations and Results: After the diagnosis, 31 patients were enrolled. The age of the patients ranged from 10 to 65years. Male to female ratio was 1.8:1. The average duration of symptoms before presentation was 8 months. Almost all the patients were requiring regular component support with packed red cells and platelets before starting therapy. 20 patients were randomized to receive CSA. Out of 20, 3 patients were lost to follow up due to financial constraints and 1 patient discontinued therapy due to renal dysfunction, finally 16 patients were analyzed. In this group 9 out of 16 (56.5%) responded to treatment. 11 patients were assigned to ATG & CSA group. 3 patients died within two months of therapy, these were excluded from the study, and finally 8 patients were analyzed. In this group 5 out of 8 (62.5%) responded. Conclussion: CSA treatment is as efficacious as ATG+CSA combination therapy for acquired idiopathic aplastic anemia, otherwise not eligible for BMT from HLA-identical siblings.
Keywords: Cyclosporin A, Hypocellularmarrow, Packedredcelltransfusion, Thrombocytopenia, Bone marrow transplantation, Neutropenia.
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