López-Karpovitch X, Gil-Rondero C, Hurtado-Monroy R
Departamento de Hematología, Instituto Nacional de la Nutrición, Salvador Zubirán, México, D.F.
Rev Invest Clin. 1991 Apr-Jun;43(2):162-6.
Four males and two females, aged 13 to 57 years (median 22 years), with acquired severe aplastic anemia (AA) were treated with intravenous bolus of high doses of 6-methylprednisolone (MPL). Patients received MPL within a 30-day period at a dose of 20 mg/kg/day (3 days), 10 mg/kg/day (4 days), 5 mg/kg/day (4 days), 2 mg/kg/day (9 days), and 1 mg/kg/day (10 days). Within the first 3 months following MPL therapy, a response rate of 83%, assessed by means of increase in reticulocytes, neutrophils or platelets, was recorded in the group: two cases showed partial response and three improvement. The 3-month, and 1-, 2- and 3-year survival of the group was 67%, 50%, 33% and 33%, respectively. Neither the presence of reticulocytopenia or thrombocytopenia prior MPL therapy, nor age, gender, etiology of AA or time between diagnosis and initiation of MPL influenced survival. In contrast, neutrophil counts before MPL treatment had a strong prognostic value. Patients with less than 0.5 x 10(9)/L neutrophils had a median survival of 4.2 months (range 1.2 to 5.2 months) as compared to the 36.1 months median survival (range 12.1 to 36.8 months) of patients whose neutrophil counts were greater than 0.5 x 10(9)/L. Follow-up data suggest that the administration of androgens two months after MPL therapy did not modify survival. It is concluded that high-dose MPL is useful in the treatment of some patients with acquired severe AA, particularly in those with greater than 0.5 x 10(9)/L neutrophils who are not candidates for bone marrow transplantation.
4名男性和2名女性，年龄在13至57岁之间（中位数为22岁），患有获得性重度再生障碍性贫血（AA），接受了大剂量6-甲基泼尼松龙（MPL）静脉推注治疗。患者在30天内接受MPL治疗，剂量为20mg/kg/天（3天）、10mg/kg/天（4天）、5mg/kg/天（4天）、2mg/kg/天（9天）和1mg/kg/天（10天）。在MPL治疗后的前3个月内，通过网织红细胞、中性粒细胞或血小板增加来评估，该组的缓解率为83%：2例显示部分缓解，3例病情改善。该组3个月以及1年、2年和3年生存率分别为67%、50%、33%和33%。MPL治疗前存在网织红细胞减少或血小板减少，以及年龄、性别、AA病因或诊断与开始MPL治疗之间的时间，均不影响生存率。相比之下，MPL治疗前的中性粒细胞计数具有很强的预后价值。中性粒细胞计数低于0.5×10⁹/L的患者中位生存期为4.2个月（范围为1.2至5.2个月），而中性粒细胞计数大于0.5×10⁹/L的患者中位生存期为36.1个月（范围为12.1至36.8个月）。随访数据表明，MPL治疗两个月后给予雄激素并不能改变生存率。结论是，大剂量MPL对一些获得性重度AA患者的治疗有用，特别是对那些中性粒细胞计数大于0.5×10⁹/L且不适合进行骨髓移植的患者。
