Yamazaki Hirohito
Division of Transfusion Medicine, Kanazawa University Hospital.
Rinsho Ketsueki. 2023;64(9):892-899. doi: 10.11406/rinketsu.64.892.
The "Reference Guide for the Treatment of Aplastic Anemia" has been revised for the first time in 3 years, and clinical questions have been formulated for the first time. As research demonstrated a benefit to combining antithymocyte globulin (ATG) and cyclosporine with eltrombopag (EPAG), the revised guide recommends that EPAG be started as soon as possible after ATG administration. In addition, it states that starting with immunosuppressive therapy and performing allogeneic bone marrow transplantation in the event of inadequate response or relapse is an option even for young adult patients with severe aplastic anemia who have HLA-matched allogeneic bone marrow donor candidates. The guide also discusses aggressive treatment of non-severe cases, ATG dosage and the maximum age for ATG administration, infection prevention, and G-CSF administration. It is necessary to continue collecting evidence and promoting clinical trials to build evidence in Japan.
《再生障碍性贫血治疗参考指南》三年来首次修订，并首次提出了临床问题。随着研究表明抗胸腺细胞球蛋白（ATG）、环孢素与艾曲泊帕（EPAG）联合使用有益，修订后的指南建议在给予ATG后尽快开始使用EPAG。此外，指南指出，即使是有HLA匹配的异基因骨髓供体候选人的重度再生障碍性贫血年轻成年患者，开始采用免疫抑制治疗，若反应不足或复发则进行异基因骨髓移植也是一种选择。该指南还讨论了非重症病例的积极治疗、ATG剂量和ATG给药的最大年龄、感染预防以及粒细胞集落刺激因子（G-CSF）的给药。在日本，有必要继续收集证据并推动临床试验以积累证据。
