Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide

William J. Savage, Patricia A. DeRusso, Linda M. Resar, Allen R. Chen, Meghan A. Higman, David M. Loeb, Richard J. Jones, Robert A. Brodsky

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective. Demonstrate that high-dose cyclophosphamide (CY) is effective therapy for hepatitis-associated aplastic anemia (HAA). Background. HAA is a sequence of seronegative hepatitis followed by aplastic anemia. Optimal treatment is matched-sibling allogeneic bone marrow transplantation (BMT). The combination of antithymocyte globulin (ATG) and cyclosporine (CSA) has also been studied, but there are scarce data regarding treatment of HAA. Procedure. Five patients (median age 14 years; range 6-17 years) with HAA and without an HLA-matched sibling were treated with high-dose CY (50 mg/kg/day IV x 4 days) followed by granulocyte-colony stimulation factor (G-CSF). Results. After at least 1 year of follow-up, four of five patients are in remission without further immune suppression beyond high-dose CY. Of the 4 responders, median time to absolute neutrophil count (ANC) >500 μl-1 was 51 days (range 44-369). Median time to transfusion independence for erythrocytes and platelets was 109 (range 57-679) and 160 (range 48-679) days, respectively. The fifth patient did not respond and proceeded to an unrelated donor transplant. One patient met criteria for autoimmune hepatitis (AIH) in addition to HAA. In this case, high-dose CY successfully induced remission of both diseases. Conclusions. High-dose CY induces durable remissions in HAA and may be an effective treatment for AIH.

Original languageEnglish (US)
Pages (from-to)947-951
Number of pages5
JournalPediatric Blood and Cancer
Volume49
Issue number7
DOIs
StatePublished - Dec 1 2007
Externally publishedYes

Fingerprint

Aplastic Anemia
Cyclophosphamide
Hepatitis
Autoimmune Hepatitis
Therapeutics
Siblings
Erythrocyte Transfusion
Unrelated Donors
Platelet Transfusion
Antilymphocyte Serum
Homologous Transplantation
Bone Marrow Transplantation
Granulocytes
Cyclosporine
Neutrophils
Transplants

Keywords

  • Aplastic anemia
  • Autoimmune
  • Cyclophosphamide
  • Hepatitis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Savage, W. J., DeRusso, P. A., Resar, L. M., Chen, A. R., Higman, M. A., Loeb, D. M., ... Brodsky, R. A. (2007). Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide. Pediatric Blood and Cancer, 49(7), 947-951. https://doi.org/10.1002/pbc.21143

Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide. / Savage, William J.; DeRusso, Patricia A.; Resar, Linda M.; Chen, Allen R.; Higman, Meghan A.; Loeb, David M.; Jones, Richard J.; Brodsky, Robert A.

In: Pediatric Blood and Cancer, Vol. 49, No. 7, 01.12.2007, p. 947-951.

Research output: Contribution to journalArticle

Savage, WJ, DeRusso, PA, Resar, LM, Chen, AR, Higman, MA, Loeb, DM, Jones, RJ & Brodsky, RA 2007, 'Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide', Pediatric Blood and Cancer, vol. 49, no. 7, pp. 947-951. https://doi.org/10.1002/pbc.21143
Savage, William J. ; DeRusso, Patricia A. ; Resar, Linda M. ; Chen, Allen R. ; Higman, Meghan A. ; Loeb, David M. ; Jones, Richard J. ; Brodsky, Robert A. / Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide. In: Pediatric Blood and Cancer. 2007 ; Vol. 49, No. 7. pp. 947-951.
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N2 - Objective. Demonstrate that high-dose cyclophosphamide (CY) is effective therapy for hepatitis-associated aplastic anemia (HAA). Background. HAA is a sequence of seronegative hepatitis followed by aplastic anemia. Optimal treatment is matched-sibling allogeneic bone marrow transplantation (BMT). The combination of antithymocyte globulin (ATG) and cyclosporine (CSA) has also been studied, but there are scarce data regarding treatment of HAA. Procedure. Five patients (median age 14 years; range 6-17 years) with HAA and without an HLA-matched sibling were treated with high-dose CY (50 mg/kg/day IV x 4 days) followed by granulocyte-colony stimulation factor (G-CSF). Results. After at least 1 year of follow-up, four of five patients are in remission without further immune suppression beyond high-dose CY. Of the 4 responders, median time to absolute neutrophil count (ANC) >500 μl-1 was 51 days (range 44-369). Median time to transfusion independence for erythrocytes and platelets was 109 (range 57-679) and 160 (range 48-679) days, respectively. The fifth patient did not respond and proceeded to an unrelated donor transplant. One patient met criteria for autoimmune hepatitis (AIH) in addition to HAA. In this case, high-dose CY successfully induced remission of both diseases. Conclusions. High-dose CY induces durable remissions in HAA and may be an effective treatment for AIH.

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