Hepatitis Research Today is a free monthly online journal that collates and summarizes the latest research about Hepatitis, including details on hepatitis a, b, c, causes, symptoms. | ||||||||
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Treatment of hepatitis-associated aplastic anemia with high-dose cyclophosphamide.Savage WJ, DeRusso PA, Resar LM, Chen AR, Higman MA, Loeb DM, Jones RJ, Brodsky RA Department of Pediatric Oncology, Johns Hopkins Hospital, Baltimore, Maryland, USA. 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 microl(-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. Published 22 October 2007 in Pediatr Blood Cancer, 49(7): 947-51.
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