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

doi:10.1002/pbc.21143

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 journal › Article › peer-review

24 Scopus citations

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 language	English (US)
Pages (from-to)	947-951
Number of pages	5
Journal	Pediatric Blood and Cancer
Volume	49
Issue number	7
DOIs	https://doi.org/10.1002/pbc.21143
State	Published - Dec 2007
Externally published	Yes

Keywords

Aplastic anemia
Autoimmune
Cyclophosphamide
Hepatitis

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Hematology
Oncology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/pbc.21143

Cite this

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title = "Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide",

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.",

keywords = "Aplastic anemia, Autoimmune, Cyclophosphamide, Hepatitis",

author = "Savage, {William J.} and DeRusso, {Patricia A.} and Resar, {Linda M.} and Chen, {Allen R.} and Higman, {Meghan A.} and Loeb, {David M.} and Jones, {Richard J.} and Brodsky, {Robert A.}",

year = "2007",

month = dec,

doi = "10.1002/pbc.21143",

language = "English (US)",

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T1 - Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide

AU - Savage, William J.

AU - DeRusso, Patricia A.

AU - Resar, Linda M.

AU - Chen, Allen R.

AU - Higman, Meghan A.

AU - Loeb, David M.

AU - Jones, Richard J.

AU - Brodsky, Robert A.

PY - 2007/12

Y1 - 2007/12

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.

AB - 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.

KW - Aplastic anemia

KW - Autoimmune

KW - Cyclophosphamide

KW - Hepatitis

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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