Cyclosporin A (CyA) does not enhance CFU-c growth in patients with severe aplastic anaemia

Severe aplastic anemia (SAA): response to cyclosporin A (CyA) in vivo and in vitro

The aim of the present study was to test the effect of cyclosporin A (CyA) in vitro on CFU-GM growth from patients with severe aplastic anemia (SAA). For this purpose, bone marrow (BM) cells from 9 SAA patients and 5 healthy individuals were incubated with or without CyA and then cultured for CFU-GM growth in the presence of exogenous recombinant human GM-CSF (30 ng/ml). SAA patients were tested before or after treatment with CyA, or after treatment with antilymphocyte globulin (ALG). In 3 patients responding to CyA, the addition of CyA in vitro enhanced colony growth from 13 +/- 10 to 40 +/- 20/10(5) BM cells (p = 0.01) - the median increment of colony formation was 2.4-fold. In 5 ALG responders, CyA produced no increment of CFU-GM growth (from 14 +/- 26 to 15 +/- 16/10(5) BM cells, p = 0.1). CyA did not enhance significantly CFU-GM growth in normal controls (from 57 +/- 45 to 58 +/- 81/10(5) BM cells, p = 0.9). In conclusion, it would appear that some patients with SAA can respond to CyA in vivo and in vitro, and ALG responders are not necessarily among these. This is in keeping with different mechanisms of action of CyA and ALG and possibly with the existence of distinct pathogenetic pathways in SAA.

Immunomodulation therapy for severe aplastic anemia--ALG versus ALG plus cyclosporin A

Immunosuppressive treatment of aplastic anemia has been increasingly used as an alternative treatment to bone marrow transplantation. In this study, the additive effect of Cyclosporin A (CSA) (5mg/kg/day, at least 3 months) for maintenance of immunosuppression after antilymphocyte globulin (ALG) therapy (40mg/kg/day for 4 days) was compared to the previous ALG alone treatment (15mg/kg/day for 10 days). A high dose of methylprednisolone (20mg/kg/day for 5 days and 10mg/kg/day for 5 days) to the ALG group and a low dose of methylprednisolone (2mg/kg/day for 5 days) to the ALG plus CSA group were administered simultaneously. The results were as follows: 1) Sixteen (69.6%) out of twenty-three patients treated with ALG plus Cyclosporin A showed higher responses (CR: 48%, PR: 22%). On the contrary, nine out of nineteen in the ALG group showed lower responses (CR: 21%, PR: 26%). 2) Our data showed a tendency that male patients in age ranging from sixteen to thirty years showed an excellent response to ALG therapy (12/23: 52.2%). 3) The ALG plus CSA group revealed a faster response compared to the ALG alone group (15/16 within 6 months). 4) We speculate that ALG plus CSA therapy might be the treatment of choice for patients with a moderate degree of aplastic anemia. 5) Adding CSA to ALG increased the chance of infection, such as those with URI-like symptoms, but it did not affect the mortality rate. Our data suggest that the ALG plus CSA regimen may be a more useful therapeutic modality for patients with severe aplastic anemia who cannot be candidates for bone marrow transplantation and a randomized multicenter study is needed for confirmation of our preliminary study.

Cyclosporin treatment for aplastic anemia: a case report demonstrating a second response to second exposure to cyclosporin

Cyclosporin has been used in the treatment of aplastic anemia, often in combination with other drugs, making it difficult to make a clear distinction between the effects of cyclosporin and those of other treatments. This report demonstrates a clear response of a patient with aplastic anemia to single drug cyclosporin therapy.