Means R T, Krantz S B, Dessypris E N, Lukens J N, Niblack G D, Greer J P, Flexner J M, Stein R S
Department of Medicine, Vanderbilt University, Nashville, Tennessee.
Am J Med. 1988 Apr;84(4):678-82. doi: 10.1016/0002-9343(88)90104-0.
Twenty-two patients with aplastic anemia were treated with antilymphocyte serum or antithymocyte globulin at Vanderbilt University and affiliated hospitals from 1980 to 1986. The median age was 42 (eight to 73 years); the male:female ratio was 8:14. Nineteen patients had severe aplastic anemia, and three had moderate disease. Twenty patients received antilymphocyte serum initially while two patients received antithymocyte globulin. Fifteen patients received fluoxymesterone 10 mg by mouth three times a day with antilymphocyte serum, and all received prednisone during the course of antilymphocyte serum or antithymocyte globulin. There were seven responses (31.8 percent) to the first course with four complete responses and three partial responses. Six of 15 patients who received fluoxymesterone showed a response, compared with zero of five treated without androgens (p less than 0.05). Eight patients with no initial response and a patient who experienced a relapse after a complete response were re-treated with either antithymocyte globulin (six) or antilymphocyte serum (three), with four of nine patients (44 percent) having a response (three complete responses, one partial response). Overall, 10 of 22 patients (45 percent) had a response (six complete responses, four partial responses). Median survival for those without a response is six months. Median survival for those with a response has not been reached, with follow-up ranging from 18 to 70 months. This study shows the benefit of a second cycle of antilymphocyte serum or antithymocyte globulin and a possible role for concomitant androgens in this treatment of aplastic anemia.
1980年至1986年期间，范德堡大学及其附属医院对22例再生障碍性贫血患者使用了抗淋巴细胞血清或抗胸腺细胞球蛋白进行治疗。患者年龄中位数为42岁（8至73岁）；男女比例为8:14。19例患者为重型再生障碍性贫血，3例为中型。20例患者最初接受抗淋巴细胞血清治疗，2例接受抗胸腺细胞球蛋白治疗。15例患者在使用抗淋巴细胞血清的同时口服氟甲睾酮，每日3次，每次10 mg，所有患者在接受抗淋巴细胞血清或抗胸腺细胞球蛋白治疗期间均接受泼尼松治疗。首个疗程有7例出现反应（31.8%），其中4例完全缓解，3例部分缓解。接受氟甲睾酮治疗的15例患者中有6例出现反应，而未使用雄激素治疗的5例患者无一例有反应（P<0.05）。8例初始无反应的患者以及1例完全缓解后复发的患者接受了抗胸腺细胞球蛋白（6例）或抗淋巴细胞血清（3例）再次治疗，9例患者中有4例（44%）出现反应（3例完全缓解，1例部分缓解）。总体而言，22例患者中有10例（45%）出现反应（6例完全缓解，4例部分缓解）。无反应患者的生存中位数为6个月。有反应患者的生存中位数尚未达到，随访时间为18至70个月。本研究显示了抗淋巴细胞血清或抗胸腺细胞球蛋白第二个疗程的益处以及雄激素在此再生障碍性贫血治疗中可能发挥的作用。
