老年重型再生障碍性贫血的治疗

Treatment for elder patients with severe aplastic anemia

免疫抑制治疗(IST)被推荐为60岁以上重型再生障碍性贫血(SAA)或极重型再生障碍性贫血(VSAA)的首选方案,但该人群合并症较多,加之既往疗效欠佳,故应用并不广泛。目前老年SAA的治疗选择差异非常大,且其选择往往不完全基于客观标准。年龄本身并不是老年SAA使用IST的限制性因素,如果老年患者一般状态良好,且合并症指数评分较低,则可将此方案作为一线治疗方案;身体状态不佳或有严重合并症的患者,可予环孢素A单独或联合其他药物治疗。此外,做好支持治疗对该人群的生存亦有很大影响。

Immunosuppressive therapy(IST)is recommended as the first choice of treatment regimens in elder patients(≥60 years)with severe aplastic anemia(SAA)or very severe aplastic anemia(VSAA).However,this treatment was not widely used due to the large number of complications in this population and the poor efficacy in the past.The current therapeutic choices in elderly patients with SAA are various and are not based on objective criteria.Age is not a limiting factor to SAA treatment with IST.This regimen should be used as first-line treatment in elderly patients if they have a good general state and low comorbidity index score.For patients with poor general state or with severe complications,cyclosporine A alone or in combination with other drugs may be used.In addition,supportive care may have a great impact on survival in this population.