Antilymphocyte Globulin, Cyclosporin, and Granulocyte Colony-Stimulating Factor in Patients With Acquired Severe Aplastic Anemia (SAA):

Patients with severe aplastic anemia (SAA) and a neutrophil (PMN) count of less than 0.5 x 109/L are exposed to a high risk of early mortality when treated with antilymphocyte globulin (ALG) and steroids, with the major problem being infectious complications. The addition of human recombinant granulocyte colony-stimulating factor (rhG-CSF) to ALG may reduce early mortality by improving neutrophil counts in the short term. To test the feasibility of this approach, the SAA Working Party of the European Group for Blood and Marrow Transplantation (EBMT) designed a pilot study that included rhG-CSF (5 pglkgld. days 1 through 90). horse ALG (HALG; 15 mg/kg/d, days 1 through 51, methylprednisolone (2 mg/kg/d, days 1 through 5, then tapering the dose), and cyclosporin A (CyA; 5 mg/kg/d orally, days 1 through 180). Patients with newly diagnosed acquired SAA (untreated) and with neutrophil counts of 50.5 x 109/L were eligible. Forty consecutive patients entered this study and are evaluable with a minimum follow up of 120 days: the median age was 16 years (range, 2 to 72 years), the interval from diagnosis to treatment was 24 days, and the median