Acquired amegakaryocytic thrombocytopenia (AAMT) is an unusual disease characterized by severe thrombocytopenia resulting from a marked decrease in bone marrow megakaryocytes. Various pathogenic mechanisms have been suggested, and several treatments have been tried, with varying outcomes. In some case reports, cyclosporine and anti-thymocyte globulin have had good clinical results in the treat of AAMT. There are few reports on the treatment of relapsed AAMT with cyclosporine. We report a patient with relapsed AAMT who was treated successfully with an additional course of cyclosporine. The initial remission was achieved with cyclosporine 4 years earlier and a second remission was induced by cyclosporine. Cyclosporine may be effective for relapsed AAMT that previously responded to cyclosporine.
Antilymphocyte Serum ; Bone Marrow ; Cyclosporine* ; Humans ; Megakaryocytes ; Thrombocytopenia*

PURPOSE: We evaluated the response to immunomodulation therapy, long-term survival and relapse rate of aplastic anemia during follow-up for more than 1 year. METHODS: Twenty-eight children, with moderate to severe aplastic anemia were followed for more than one year and 7 children expired after therapy, were analyzed. Antilymphocyte globulin (ALG) or antithymocyte globulin (ATG) by itself was given to 27 patients, and cyclosporine A (CsA) combined with ALG was given to 8 patients. ALG (ATG) was administered for 8 days in 20mg/kg/day when used alone, and for 5 days in 10mg/kg/day when combined with CsA. CsA was orally administered on the 14th day till 180th day of therapy, with 5mg/kg/day for first 14 days and 3mg/kg/day thereafter. RESULTS: Fifteen out of 35 patients (43%) showed a response. Median interval to response was 3 month (1-40 months). Response rate to ALG + CsA was 50%, compared to 41% in ALG (or ATG) alone. The interval of aplastic anemia symptoms to treatment showed a tendency to be shorter in responders (4.1 +/- 2.2 months) than in non-responders (17.5 +/- 6.4 months). Relapse occurred in 3 of 15 responders (20%). Evolution to secondary clonal hematologic disorders was not observed. Overall actuarial survival at 3 year was 78.2%. CONCLUSION: The results of immunomodulation therapy suggest that response would be better for patients whose interval from symptoms of aplastic anemia to treatment is short. Our results also suggest that ALG+CsA would be a better treatment modality to improve response rate.
Anemia, Aplastic* ; Antilymphocyte Serum ; Child ; Cyclosporine ; Follow-Up Studies* ; Humans ; Immunomodulation* ; Recurrence*

Although acute humoral rejection is a major cause of renal allograft loss, the diagnosis and treatment of acute humoral rejection have been very difficult because of lack of proper diagnostic tools and effective therapeutic modalities. Recently C4d deposition in peritubular capillaries of renal allografts has been demonstrated to be a sensitive and diagnostic in-situ marker of humoral rejection that correlates strongly with the presence of circulating donor-specific antibodies. Whereas conventional immunosuppressive agents are effective for the treatment of cellular rejection, specific therapeutic strategies targeting the humoral limb of immunosuppression should be necessary for the treatment of humoral rejection. Here we report a case of acute humoral rejection diagnosed with C4d immunostaining from transplant kidney biopsy and treated successfully with combination of plasma exchange, polyclonal rabbit anti-thymocyte globulin, and rituximab.
Allografts ; Antibodies ; Antilymphocyte Serum ; Biopsy ; Capillaries ; Diagnosis ; Extremities ; Immunosuppression ; Immunosuppressive Agents ; Kidney ; Plasma Exchange* ; Plasma* ; Rituximab

OBJECTIVETo analyze the clinical characteristics of cytomegalovirus(CMV) infection after allogenic hematopoietic stem cell transplantation(allo-HSCT) and the effect of preemptive therapy.

METHODSA total of 134 patients who underwent allo-HSCT from March 2010 to March 2015 in the Department of Hematology of our hospital were enrolled in this study. The CMV infection rate, the median time of CMV infection occurence, and the risk factors for CMV infection after allo-HSCT, the response rate of preemptive treatment and the median time of CMV-DNA turning negative were analyzed. Five-year overall survival rate was compared between the patients with or without CMV infection.

RESULTSThe incidence of CMV viremia was 55.2％(74／134), and the median time for the CMV with CMV-DNA positive for the first time was 34 days(14-283) after allo-HSCT．Both univariate and multivariate analysis showed that the thymoglobulin(ATG) used in conditioning regimen and Ⅱ-Ⅳ grade of aGVHD were the risk factors for CMV viremia. After preemptive treatment the 85.1% of patient with CMV viremia turned negative, and the median time of CMV-DNA turning negative were 15 days(5-82), only 2 patients died of CMV pneumonia. Five-year overall survival rate of the patients with or wihout CMV viremia was 49% and 66.3% respectively, and the difference between the 2 groups was significant(P=0.041）.

CONCLUSIONThe ATG used in conditioning regimen and Ⅱ-Ⅳ grade of aGVHD may increase the incidence of CMV infection after allo-HSCT, and the preemptive thrapy can effectively prevent the CMV viremia turning to CMV disease.

Antilymphocyte Serum ; Cytomegalovirus Infections ; Hematopoietic Stem Cell Transplantation ; Humans ; Incidence ; Risk Factors ; Transplantation Conditioning ; Transplantation, Homologous

Antilymphocyte Serum ; HLA Antigens ; immunology ; Hematopoietic Stem Cell Transplantation ; Humans ; Isoantibodies ; Prognosis ; Transplantation, Homologous

OBJECTIVETo compare the efficacy of porcine and rabbit antithymocyte globulins (ATG) in the treatment of severe aplastic anemia (SAA).

METHODSWe reviewed the clinical data of 43 SAA patients receiving porcine ALG treatment and 32 patients receiving rabbit ATG treatment between 2004 and 2013 in our hospital. The overall response rates of the patients at 6 month were compared, and the patients' survival in the two groups was analyzed using Kaplan-Meier survival curves.

RESULTSThe overall response rates at 6 months was significantly higher in porcine ALG group than in rabbit ATG group (79.07% vs 56.25%, P=0.034). The 5-year overall survival was also higher in porcine ALG group than in rabbit ATG group, but this difference was not statistically significant (86.047% vs 72.878%, P=0.190).

CONCLUSIONSPorcine ALG is superior over rabbit ATG in terms of hematological response but is comparable with rabbit ATG in view of the patients' survival and safety.

Anemia, Aplastic ; therapy ; Animals ; Antilymphocyte Serum ; therapeutic use ; Humans ; Kaplan-Meier Estimate ; Rabbits ; Retrospective Studies ; Swine

Aplastic anemia is characterized by multilineage bone marrow failure resulting in pancytopenia. There is no effective therapy for patients with severe aplastic anemia who were refractory to immunosuppresive therapy including antithymocyte globulin (ATG) or relapsed after allogeneic bone marrow transplantation. We report hereby that two patients with severe aplastic anemia who were relapsed after immu-nosuppresive therapy with ATG and cyclosporine A were successfully treated with low dose erythropoietin. Observed trilineage hematologic response was dependent on low dose erythropoietin therapy.
Anemia, Aplastic* ; Antilymphocyte Serum ; Bone Marrow ; Bone Marrow Transplantation ; Cyclosporine ; Erythropoietin* ; Humans ; Pancytopenia

No abstract available.
Anemia, Aplastic* ; Antilymphocyte Serum* ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocytes* ; Humans*

No abstract available.
Antilymphocyte Serum ; Humans ; Leukemia ; Myelodysplastic Syndromes ; Peripheral Blood Stem Cell Transplantation ; Tissue Donors

Anemia, Aplastic/drug therapy* ; Animals ; Antilymphocyte Serum ; Child ; Cyclosporine ; Humans ; Immunosuppressive Agents ; Swine ; Treatment Outcome