Treatment and prognosis-Aplastic anemia

Immunosuppression

CsA/tacrolimus, ATG antithymocyte immunoglobulin

• 70-80% respond
• 80-90% 5-y survival
  • (96% vs. 76% w/ horse vs. rabbit ATG; NEJM 2011;365:430);
• 15-20% 10-y incidence of clonal disorders
  • (mostly MDS, AML, PNH)
• Anti-lymphocyte, anti-thymocyte globulin (ALG,ATG)

TPO mimetics (eg, eltrombopag)

• 1st-line w/ immunosuppression (NEJM 2022;386:11)

Supportive care

• transfusions : bleeding 或血小板<5,000-10,000/μL 就要輸血
• abx
• possible utility of G-CSF
• Epo (if Epo <500)

Allogeneic HSCT

• young Pts

  • → ~80% long-term survival
  • ↓ risk malignant, but has
  • risk of transplant-related m&m

• if possible,

  • avoid transfusions : risk of alloimmunization @ pretransplant