Hinterberger-Fischer M, Hinterberger W, Höckern P, Schmidmeier W, Gadner H, Geissler K, Kos M, Schwarzinger I, Neumann E, Niessner H
Acta Haematol. 1986;76(4):196-201. doi: 10.1159/000206055.
Fifteen patients with transfusion-dependent severe aplastic anemia (SAA) were treated with combined immunosuppression consisting of horse-antithymocyte globulin (ATG; Atgam, Upjohn) and high-dose 6-methylprednisolone (MP). Oxymetholone was scheduled for 2 years but was discontinued in 7 patients after 10-385 days due to liver toxicity. Serious side effects usually seen in ATG monotherapy were rare during combined immunosuppression. Currently 12 of 15 patients are alive 110-1,275 days (median 475.5) after start of treatment. One patient has received too short treatment to be evaluated. All the others are transfusion-independent. Three patients died; two from septicemia before hemopoietic recovery could be expected and one after relapse. Our results confirm that the addition of high-dose MP abrogates the side effects of ATG monotherapy, and the addition of MP does not counteract, but rather enhances the beneficial effect of ATG in SAA. We recommend combined immunosuppressive treatment with ATG and high-dose MP as a highly feasible, safe and effectful therapy for patients with transfusion-dependent SAA.
15例依赖输血的重型再生障碍性贫血（SAA）患者接受了由马抗胸腺细胞球蛋白（ATG；Atgam，Upjohn公司）和大剂量6-甲基泼尼松龙（MP）组成的联合免疫抑制治疗。氧甲氢龙计划使用2年，但7例患者在10 - 385天后因肝毒性而停药。联合免疫抑制治疗期间，ATG单一疗法中常见的严重副作用很少见。目前，15例患者中有12例在治疗开始后110 - 1275天（中位值475.5天）存活。1例患者接受治疗时间过短，无法评估。其他所有患者均不再依赖输血。3例患者死亡；2例在预期造血恢复前死于败血症，1例在复发后死亡。我们的结果证实，添加大剂量MP可消除ATG单一疗法的副作用，且添加MP不会抵消，反而会增强ATG对SAA的有益作用。我们推荐将ATG和大剂量MP联合免疫抑制治疗作为依赖输血的SAA患者高度可行、安全且有效的治疗方法。
