Abstract
We studied the efficacy of antilymphocyte globulin (ALG) and antithymocyte globulin (ATG) in the treatment of 40 cases of moderate to severe aplastic anemia in children. These included 32 cases of idiopathic type, one case of Fanconi's anemia, 3 cases of secondary type, and 4 cases of Blackfan-Diamond's anemia (PRCA). ALG was administered to 39 patients and ATG was administered to one patient. The ALG or ATG was infused to the patients at a rate of 20-40 mg/kg/day f or 5 days. Ten of them received a combination of ALG and high-dose methylprednisolone. Six out of 25 severe cases and one out of 10 moderate cases had a complete or partial response within 3 months, respectively. Statistically, the response rate and survival rate were not influenced by the combination of ALG and high-dose methylprednisolone. The transient improvement was observed in one case out of 4 cases of PRCA. The proportion of CD4, CD8, and CD4/CD8 ratio did not correlate with clinical response before and after ALG or ALT therapy. Complications were minimal and included moderate fever, urticaria, exanthema, and glucosuria. Combination therapy with ALT or ALG and high-dose methylprednisolone should be considered in childhood severe aplastic anemia when bone marrow transplantation is not possible.
