PRACTICAL ASPECTS IN THE DIAGNOSIS AND MANAGEMENT OF APLASTIC-ANEMIA

Aplastic anemia may result from several pathogenic mechanisms, the mos t common is idiopathic. The current definitive treatments for aplastic anemia are bone marrow transplantation (BMT) or immunosuppressive (IS ) therapy, The benefits of each are comparable, However, certain subse ts of patients derive superior benefit from one or the other, Bone mar row transplantation is the initial treatment of choice for young patie nts (<20 years old), It results in the complete reconstitution of hema topoiesis, whereas autologous hematopoietic remissions after IS therap y are more susceptible to relapse, Survival rates after BMT, in patien ts between the ages of 20 and 40, are comparable to those reported for IS therapy, Better survival rates after BMT have been achieved with i mproved conditioning regimens and graft-versus-host disease prophylaxi s, For patients older than 40, the treatment of choice is IS, Long-ter m complications of IS therapy include recurrence and development of cl onal myeloid disorders, Long-term complications after BMT include graf t-versus-host disease and secondary neoplasms, The IS regimen includes the combination of antithymocyte globulin and cyclosporin A, The addi tion of growth factor to the IS regimen seems promising; however, thei r use on their own is not recommended, Androgens have been shown to be inferior in the treatment of aplastic anemia, The role of BMT from an unrelated donor is being investigated.