Objective: To evaluate the efficacy and safety of intensive immunosupressive therapy (IST) with antithymocyte/antilymphocyte globulin plus cyclosporine A in the treatment of older patients (≥60 years) with severe aplastic anemia (SAA).
Methods: The hematologic response and safety of sixteen older SAA patients treated with IST regimen in our hospital were retrospectively analyzed , and the factors affecting response were also explored.
Results: A total of 16 older SAA patients were involved, the median age was 63.5 (60-79) years. Among them, 7 were VSAA and 9 were SAA; 9 patients received Rabbit anti- human thymocyte globulin (rATG), and 7 patients porcine anti- human lymphocyte globulin (pALG). Two patients died within 3 months after IST; at the 6 months after IST, 9 patients achieved hematology response and 5 patients had no response; overall response rate was 56.3%. Two (22%) of the 9 patients treated with rATG achieved hematology response; However, all 7 patients (100.0%) treated with pALG achieved hematology response. rATG/pALG associated adverse reactions were mild and easily managed.
Conclusion: The older patients with SAA could still benefit from IST consisting of standard dose rATG/pALG with CsA, and the patients with VSAA had worse prognosis, pALG was inferior to rATG as a first treatment for SAA.
目的: 评估老年（≥60岁）重型再生障碍性贫血（SAA）患者接受兔抗人胸腺细胞球蛋白（rATG）／猪抗人淋巴细胞球蛋白（pALG）联合环孢素A(CsA）的强烈免疫抑制治疗（IST）方案的疗效和安全性。
方法: 回顾性分析16例老年SAA患者接受rATG/pALG+CsA治疗的血液学反应率和安全性，分析影响疗效的相关因素。
结果: 16例患者男13例，女3例，中位年龄63.5(60~79）岁，其中60~69岁13例，≥70岁3例；SAA患者9例，极重型AA(VSAA）患者7例；9例患者接受rATG治疗，7例患者接受pALG治疗。16例患者均顺利完成rATG/pALG治疗，治疗后早期死亡2例（12.5%），均为VSAA患者（2/7, 28.6%）；IST后6个月9例（56.3%）患者获得血液学反应，5例无治疗反应。9例应用rATG的患者有2例获得血液学反应，7例应用pALG患者全部获得血液学反应，差异有统计学意义（22.2％对100.0%，P=0.003）。rATG/pALG+CsA相关不良反应轻微，经对症治疗好转。
结论: 老年SAA接受rATG/pALG联合CsA的IST方案仍可获较好血液学反应；VSAA患者早期死亡率高，治疗风险大；pALG治疗老年SAA疗效可能优于rATG。