Treatment of severe aplastic anemia with bolus 6-methylprednisolone and antilymphocytic globulin

Twenty two patients with severe aplastic anemia (SAA) received bolus 6-methylprednisolone (B/6-MPr) on admission. All patients received at least 100 mg/kg of B/6-MPr intravenously on the first week of treatment. Nine patients (41%) achieved a complete autologous hematologic reconstitution and are alive and well between 118 and 760 days posttreatment. Thirteen patients were refractory: 8 of these received ALG, 3 were transplanted and 2 are being evaluated. Of the 8 patients who received ALG, 4 entered a complete autologous reconstitution and are alive and well between 420 and 735 days from therapy; 1 is alive but is still aplastic 200 days from initial treatment, and 3 died (2 of acute hemorrhage following ALG and 1 of sepsis and marrow failure on day 80). Of the 3 patients grafted 2 are complete chimeras 170 and 732 days post-transplant and 1 died of interstitial pneumonitis on day 72. The overall complete response rate to B/6-MPr and ALG was of 13 out of 17 evaluable patients (76%). Eleven have been taken off maintenance prednisolone. The overall survival of 19 patients given immunosuppression only (with the exclusion of the 3 transplanted cases) is 83% at 2 yr.