Abstract 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］
QIU Yi-Ning,BAI Yan,YU Hui et al. Therapeutic effects of a combination of high-dose immunoglobulin and cyclosporine A in children with aplastic anemia[J]. 中国当代儿科杂志, 2009, 11(01): 33-36.
QIU Yi-Ning,BAI Yan,YU Hui et al. Therapeutic effects of a combination of high-dose immunoglobulin and cyclosporine A in children with aplastic anemia[J]. CJCP, 2009, 11(01): 33-36.
［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.
