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Re-treatment of aplastic anemia with antithymocyte globulin or antilymphocyte serum

  • Robert T. Means Jr.
    Correspondence
    Requests for reprints should be addressed to Dr. Robert T. Means, Jr., Hematology Section, Room B-201, Veterans Administration Medical Center, 1310 24th Avenue South, Nashville, Tennessee 37212.
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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  • Sanford B. Krantz
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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  • Emmanuel N. Dessypris
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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  • John N. Lukens
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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  • Gary D. Niblack
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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  • John P. Greer
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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  • John M. Flexner
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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  • Richard S. Stein
    Affiliations
    Hematology Division, Department of Medicine, and the Hematology-Oncology Division, Department of Pediatrics, Vanderbilt University and Veterans Administration Medical Centers, Nashville, Tennessee, USA
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      Abstract

      Twenty-two patients with aplastic anemia were treated with antilymphocyte serum or antithymocyte globulin at Vanderbilt University and affiliated hospitals from 1980 to 1986. The median age was 42 (eight to 73 years); the male:female ratio was 8:14. Nineteen patients had severe aplastic anemia, and three had moderate disease. Twenty patients received antilymphocyte serum initially while two patients received antithymocyte globulin. Fifteen patients received fluoxymesterone 10 mg by mouth three times a day with antilymphocyte serum, and all received prednisone during the course of antilymphocyte serum or antithymocyte globulin. There were seven responses (31.8 percent) to the first course with four complete responses and three partial responses. Six of 15 patients who received fluoxymesterone showed a response, compared with zero of five treated without androgens (p <0.05). Eight patients with no initial response and a patient who experienced a relapse after a complete response were re-treated with either antithymocyte globulin (six) or antilymphocyte serum (three), with four of nine patients (44 percent) having a response (three complete responses, one partial response). Overall, 10 of 22 patients (45 percent) had a response (six complete responses, four partial responses). Median survival for those without a response is six months. Median survival for those with a response has not been reached, with follow-up ranging from 18 to 70 months. This study shows the benefit of a second cycle of antilymphocyte serum or antithymocyte globulin and a possible role for concomitant androgens in this treatment of aplastic anemia.
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