A patient aged 65 years, is diagnosed to have severe aplastic anemia. HLA compatible sibling is available. What is the BEST treatment option for this patient?
Hematopoietic stem cell transplant from an HLA identical sibling is the best therapy for younger patient with aplastic anemia. Whereas older patients do better better with antithymocyte globulin given in combination with cyclosporine. In older patients transplantation is preferred if granulocytopenia is found. Increasing age and the severity of neutropenia are the most impoant factors weighing in the decision between transplant and immunosuppression in adults who have a matched family donor: For allogeneic transplant from fully matched siblings, long-term survival rates for children are approximately 90%. Transplant morbidity and moality are increased among adults, due mainly to the higher risk of chronic GVHD and serious infections. The standard regimen of ATG in combination with cyclosporine induces hematologic recovery in 60% of patients. Improvement in granulocyte number is generally apparent within 2 months of treatment. Ref: Harrison's Principles of Internal Medicine, 18e chapter 107, By Neal S. Young.
Antithymocyte globulin followed by cyclosporine
A conventional bone marrow transplantation from the HLA identical sibling
A non-myeloablative bone marrow transplantation from the HLA identical sibling
Cyclosporine