
Therapeutic effects of a combination of high-dose immunoglobulin and cyclosporine A in children with aplastic anemia
QIU Yi-Ning, BAI Yan, YU Hui, ZHOU Dong-Feng, ZHANG Zhi-Quan, XIAO Yan, JIN Run-Ming
Chinese Journal of Contemporary Pediatrics ›› 2009, Vol. 11 ›› Issue (01) : 33-36.
Therapeutic effects of a combination of high-dose immunoglobulin and cyclosporine A in children with aplastic anemia
OBJECTIVE: To evaluate the therapeutic effects of a combined immunotherapy, high-dose immunoglobulin (HDIG) plus cyclosporine A (CsA) plus prednisone (P), in children with aplastic anemia (AA) and to explore the association of peripheral blood lymphocyte subsets, peripheral blood cells and marrow CD34+ cells with therapeutic effects in AA. METHODS: The clinical data of 46 children with AA and who received the combined immunotherapy of HDIG + CsA + P were retrospectively studied. RESULTS: Of the 46 children with AA, 31 (67.4%) were responded to the combined immunotherapy. The binary logistic regression analysis showed low absolute neutrophil count (B=4.703, P<0.05), low percentage of peripheral blood CD4+ cells (B=0.142, P<0.05) and low ratio of peripheral blood CD4+/CD8+ (B=2.945, P<0.05)were associated with poor therapeutic effects. The ratio of CD34+/karyocytes of bone marrow in children with AA was lower than that in normal individuals, but it was not significantly related to the therapeutic effect. CONCXLUSIONS: The combined immunotherapy (HDIG+ CsA+P) was effective in children with AA. The absolute neutrophil count, the percentage of peripheral blood CD4+ and the ratio of peripheral blood CD4+/CD8+ were important prognostic factors in AA.[Chin J Contemp Pediatr, 2009, 11 (1):33-36]
Immunotherapy / Immunoglobulin / Cyclosporine A / Aplastic anemia / Child
[1]中华医学会儿科学会血液组,中华儿科杂志编辑委员会.小儿再生障碍性贫血的诊疗建议[J]. 中华儿科杂志, 2001, 39(7):422.
[2]张国成,苏国平,孙新,许东亮,陈彩平,汤雪晴.我国再障患儿血清中人细小病毒B19NS基因序列测定及变异分析[J].中国当代儿科杂志,2003, 5(1):5-7.
[3]黄永兰,黄绍良,黄科,蔡耘.再生障碍性贫血患儿骨髓间充质干细胞体外生物学特性及其与免疫抑制疗效的关系[J].中国当代儿科杂志,2008,10(1):9-13.
[4]谢晓恬,王耀平,石苇.联合免疫抑制治疗儿童重型和难治型再生障碍性贫血[J].中国当代儿科杂志,2004,6(6):492-496.
[5]Erickhofen N,Heimpel H,Kaltwasser JP,Schrezenmeier H, German Aplastic Anemia Study Group.Antithymocyte globulin with or without cyclosporin A:11-year follow-up of a randomized trial comparing treatments of aplasic anemia[J]. Blood, 2003, 101(4):1236-1242.
[6]Locasciulli A, Oneto R, Bacigalupo A, Socié G, Korthof E, Bekassy A, et al. Outcome of patients with acquired aplastic anemia given first line bone marrow transplantation or immunosuppressive treatment in the last decade: a report from the European Group for Blood and Marrow Transplantation (EBMT)[J].Haematologica, 2007, 92(1): 11-18.
[7]Kennedy-Nasser AA, Leung KS, Mahajan A, Weiss HL, Arce JA, Gottschalk S, et al. Comparable outcomes of matched-related and alternative donor stem cell transplantation for pediatric severe aplastic anemia[J].Biol Blood Marrow Transplant, 2006, 12(12):1277-1284.
[8]Saracco P, Quarello P, Iori AP, Zecca M, Longoni D, Svahn J, et al. Cyclosporin A response and dependence in children with acquired aplastic anaemia: a multicentre retrospective study with long-term observation follow-up[J]. Br J Haematol, 2008, 140(2):197-205.
[9]Jeffrey KD, Eva CG. An update on the management of severe idiopathic aplastic anaemia in children[J]. Br J Haematol, 2007, 136 (4): 549-564.
[10]Howard SC, Naidu PE, Hu XJ, Jeng MR, Rodriguez Galindo C, Rieman MD, et al. Natural history of moderate aplastic anemia in children[J]. Pediatr Blood Cancer, 2004, 43(5):545-551.
[11]邵宗鸿.免疫性全血细胞减少症的分类及治疗原则[J].中国实用内科学杂志, 2006, 26(4):481-483.