Treatment results of 23 cases of severe aplastic anemia with lymphocytapheresis

Arch Med Res. 1997 Spring;28(1):85-90.

Treatment results of 23 cases of severe aplastic anemia with lymphocytapheresis.

Morales-Polanco MR, Sánchez-Valle E, Guerrero-Rivera S, Gutiérrez-Alamillo L,
Delgado-Márquez B.

Facultad de Medicina, Universidad Nacional Autónoma de México, México, D.F.

We report the results of 23 patients with aplastic anemia (AA) treated with a
program of 14 lymphocytapheresis (LC). Treatments were performed with apheresis
machines, models Haemonetics 30-S and Baxter CS3000, using the standard program.
This procedure was done because AA in many cases appears as a result of the
action of a T cell population that inhibits hematopoiesis. Theoretically, removal
of this clonal population would produce hematopoietic recovery. Of the total of
23 patients, 9 were excluded for final evaluation of treatment results because 7
died during or shortly after treatment (0.7-3 months); one patient abandoned
treatment after three LC and another died 7 months later because of
transformation to acute leukemia. The remaining 14 patients were included in the
final evaluation of treatment; seven females and seven males, average age 46.1
years (range 22-69); 13 with severe, and one with moderate AA; 11 with recently
diagnosed, and 3 with chronic AA; 12 without previous treatment and two treated
before with antilymphocyte globulin + oxymetholone (OXM) + cyclosporine A (CsA)
with transient partial remission (PR). Besides lymphocytapheresis, 13 patients
received OXM; 4 of them GM-CSF and one low dose CsA. Four patients had complete
remission lasting > 59.5 months (range 42-78); eight PR (average duration of >
38.6 months), and two minimal remission (> 37 and 29 months). Platelet,
reticulocyte and granulocyte counts increased on average at 48.7, 73.3 and 91.4
days, respectively. In conclusion, 14 (60.8%) of 23 patients with AA showed an
improvement related to LC treatment, with a survival probability of 63% from the
fourth month, the latter with an added beneficial effect of the other therapies
used. Larger numbers of patients have to be treated with LC to determine its real
usefulness, mechanism of action and the best conditions for its use.