ACQUIRED APLASTIC-ANEMIA - OPTIMUM IMMUNOSUPPRESSIVE TREATMENT

Aplastic anaemia can be cured either by bone marrow transplantation, w hich leads to stem cell replacement after a myeloablative conditioning regimen, or with nonreplacement therapy, often referred to as immunos uppressive therapy. Antilymphocyte globulin and cyclosporin are used, either alone or in association, as the cornerstone of immunosuppressiv e therapy for aplastic anaemia. Both cyclosporin and antilymphocyte gl obulin used alone induce remission in nearly 50% of patients, and long term follow-up of large cohorts indicates survival rates in the range of 60 to 70%. Immunosuppressive therapy should be first-line treatmen t for patients without a tissue-identical sibling and for those over 4 0 to 45 years of age. However, aplastic anaemia is a rare disease and some questions regarding the optimum immunosuppressive therapy remain to be answered. As a rule in rare diseases, these questions are best a nswered through multicentre prospective randomised trials, now in prog ress.