Immunotherapy for childhood aplastic anemia in India: a case for universal healthcare?

Aplastic anemia in childhood is a difficult condition to treat, and Nair and colleagues are to be commended for their meticulous collection of single-center data over a 22year period [1]. They evaluated the efficacy of immunosuppressive therapy (IST) with antithymocyte globulin (ATG) and cyclosporine (CSA) on 33 pediatric patients with acquired aplastic anemia in the Indian setting. Their results indicate that in India, with appropriate supportive care, pediatric aplastic anemia patients treated with IST can achieve response rates similar to North America and Europe, where the response rate is as high as 81% [2]. In addition, they confirm the experience of other authors, that ATG and CSA alone are the backbone of IST in treating childhood aplastic anemia, and that administration of G-CSF reduced infectious complications, but had no impact on survival or outcome [3].