ATG／ALG联合环孢素A治疗老年重型再生障碍性贫血16例疗效及安全性评估

Antithymocyte/Antilymphocyte globulin plus cyclosporine A therapy for the treatment of older patients with severe aplastic anemia

目的评估老年（1〉60岁）重型再生障碍性贫血（sAA）患者接受兔抗人胸腺细胞球蛋白（rATG）／猪抗人淋巴细胞球蛋白（pALG）联合环孢素A（CsA）的强烈免疫抑制治疗（IST）方案的疗效和安全性。方法回顾性分析16例老年SAA患者接受rATG／pALG＋CsA治疗的血液学反应率和安全性，分析影响疗效的相关因素。结果16例患者男13例，女3例，中位年龄63．5（60～79）岁，其中60～69岁13例，I〉70岁3例；SAA患者9例，极重型AA（VSAA）患者7例；9例患者接受rATG治疗，7例患者接受pALG治疗。16例患者均顺利完成rATG／pALG治疗，治疗后早期死亡2例（12．5％），均为VSAA患者（2／7，28．6％）；IST后6个月9例（56．3％）患者获得血液学反应，5例无治疗反应。9例应用rATG的患者有2例获得血液学反应，7例应用pALG患者全部获得血液学反应，差异有统计学意义（22．2％对100．0％，P=0．003）。rATG／pALG＋CsA相关不良反应轻微，经对症治疗好转。结论老年SAA接受rATG／pALG联合CsA的IST方案仍可获较好血液学反应；VSAA患者早期死亡率高，治疗风险大；pALG治疗老年SAA疗效可能优于rATG。

Objective To evaluate the efficacy and safety of intensive immunosupressive therapy （IST） with antithymocyte/antilymphocyte globulin plus cyclosporine A in the treatment of older patients （I〉60 years） with severe aplastic anemia （SAA）. Methods The hematologic response and safety of sixteen older SAA patients treated with IST regimen in our hospital were retrospectively analyzed, and the factors affecting response were also explored. Results A total of 16 older SAA patients were involved, the median age was 63.5 （60-79） years. Among them, 7 were VSAA and 9 were SAA; 9 patients received Rabbit anti-human thymocyte globulin （rATG）, and 7 patients porcine anti-human lymphocyte globulin （pALG）. Two patients died within 3 months after IST; at the 6 months after IST, 9 patients achieved hematology response and 5 patients had no response; overall response rate was 56.3%. Two （22%） of the 9 patients treated with rATG achieved hematology response; However, all 7 patients （100.0%） treated with pALG achieved hematology response, rATG/pALG associated adverse reactions were mild and easily managed. Conclusion The older patients with SAA could still benefit from IST consisting of standard dose rATG/pALG with CsA, and the patients with VSAA had worse prognosis, pALG was inferior to rATG as a first treatment for SAA.