TREATMENT RESULTS OF 23 CASES OF SEVERE APLASTIC-ANEMIA WITH LYMPHOCYTAPHERESIS

We report the results of 23 patients with aplastic anemia (AA) treated with a program of 14 lymphocytapheresis (LC). Treatments were perform ed with apheresis machines, models Haemonetics 30-S and Baxter CS3000, using the standard program. This procedure was done because AA in man y cases appears as a result of the action of a T cell population that inhibits hematopoiesis. Theoretically, removal of this clonal populati on would produce hematopoietic recovery. Of the total of 23 patients, 9 were excluded for final evaluation of treatment results because 7 di ed during or shortly after treatment (0.7-3 months); one patient aband oned treatment after three LC and another died 7 months later because of transformation to acute leukemia. The remaining 14 patients were in cluded in the final evaluation of treatment; seven females and seven m ales, average age 46.1 years (range 22 - 69); 13 with severe, and one with moderate AA; 11 with recently diagnosed, and 3 with chronic AA; 1 2 without previous treatment and two treated before with antilymphocyt e globulin + oxymetholone (OXM) + cyclosporine A (CsA) with transient partial remission (PR). Besides lymphocytapheresis, 13 patients receiv ed OXM; 4 of them GM-CSF and one low dose CsA. Four patients had compl ete remission lasting >59.5 months (range 42 - 78); eight PR (average duration of >38.6 months), and two minimal remission (>37 and 29 month s). Platelet, reticulocyte and granulocyte counts increased on average at 48.7, 73.3 and 91.4 days, respectively. In conclusion, 14 (60.8%) of 23 patients with AA showed an improvement related to LC treatment, with a survival probability of 63% from the fourth month, the latter w ith an added beneficial effect of the other therapies used. Larger num bers of patients have to be treated with LC to determine its real usef ulness, mechanism of action and the best conditions for its use.