RESUMEN
Between January 1986 and July 1990, 17 patients with acquired aplastic anemia were treated with ALG or ATG combined with high doses of methylprednisolone. The mean age was 24.3 years (from 4 to 51 years). There were 9 cases with idiopathic etiology of acquired aplastic anemia; in 7 cases aplastic anemia was developed during or after HBsAg infection. In one case aplastic anemia was developed during tuberculous kidney infection. The remission of the disease was achieved in 11 of 17 cases (complete remission in 9-53%, and partial in 2-12% patients). Six (35%) patients did not respond to the treatment with ALG. One patient died of infection and hemorrhagic complications, two weeks after the therapy, without responding to the treatment with ALG. The four year survival rate without recidives was 65% (11/17). Four (23.5%) patients developed clonal diseases: PNH in 2; MDS in 1 and AL in 1 patient, 24, 38, 9 and 6 months after the therapy with ALG, respectively. The age of the patients is a valuable prognostic parameter (all patients under 20 years of age entered the remission), which cannot be said for pretreatment levels of reticulocytes, neutrophils and platelets. In none of the patients adverse effects of ALG were observed. The treatment was conducted in isolated rooms with sterile air circulation. ALG combined with high doses of methylprednisolone, for the majority of patients with aplastic anemia represents a drug of choice and is an appropriate alternative therapy to alogenic bone marrow transplantation, especially for patients with no HLA identical bone marrow donor.
Asunto(s)
Anemia Aplásica/terapia , Suero Antilinfocítico/uso terapéutico , Adolescente , Adulto , Anemia Aplásica/etiología , Niño , Preescolar , Femenino , Humanos , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana EdadRESUMEN
At the Clinic for Hematology of the Military Medical Academy in Belgrade two patients had been treated from November, 1983 to July, 1986, in whom the existence of chronic myelogenous leukemia (CML) was established with negative Ph'-chromosome, as well as the existence of acquired partial erythrocyte aplasia (APEA). In the male patient of 58 years of age and the female patient of 71, APEA was established at the same time as CML. The maladies showed to be refractory to antileukemia (busulfan, hydroxyurea) and immunosuppressive (corticosteroid, androgen) therapy in both of the patients, while in the first patient splenectomy was also without effect on the course of the disease. Serumal inhibitors of erythropoiesis were not registered. After 18 months of disease duration one patient had a blastic transformation of CML into acute myeloblastic leukemia (AML) of the M1 form, and death appeared under the clinical manifestation of sepsis during iatrogenic aplasia of the bone marrow. The other patient died 32 months after start of illness because of intracranial hemorrhage, without signs of HML metamorphosis. In the discussion, previous illnesses are considered--kidney tuberculosis and polyarthralgias--as well as the applied treatment of these illnesses (antituberculotics and nonsteroid antirheumatics) as possible etiological factors in the appearance of APEA. The mutual link between APEA and CML, though exceptionally rare, is possible, and erythroblastopenia can precede or occur simultaneously with CML or during its treatment. APEA is usually the sign of CML terminal metamorphosis into acute leukemia, though it sometimes coexists with CML as an independent malady.
Asunto(s)
Leucemia Mielógena Crónica BCR-ABL Positiva/complicaciones , Aplasia Pura de Células Rojas/complicaciones , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Hemostasis , Fallo Renal Crónico/sangre , Diálisis Renal , Adolescente , Adulto , Anciano , Femenino , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana EdadRESUMEN
The effects of Prednisone therapy at two patients with pernicious anemia were studied on haematologic response, gastric secretion and gastric mucosal hystology. The treatment resulted in each case in correctin of the megaloblastic to normoblastic erythropoesis, and increse in reticulocytes, hemoglobin level and red cell count. Schilling-s test was normalised in one case that means that Prednison enchanced B12 absorption. Gastric secretion of acid and gastric hystology were not respond during the Prednisone therapy. It was discused about immunological problems in pernicious anemia which are very important and required continued investigations.