This patients hypocellular bone marrow and declining blood counts are consistent with aplastic anemia. Some studies describe marrow aplasia after treatment with fludarabine and cyclophosphamide, but the cause is unclear. A possible link between T-cell suppression and emergence of autoreactive lymphocytes has been suggested. Given the patients age, first-line therapy would be a combination of cyclosporine and ATG. Overall response rate with this therapy is 50% to 60%.2,5 Azacitidine is used to treat MDS, not aplastic anemia. Supportive care alone is not recommended for patients with aplastic anemia, as outcomes are extremely poor.
- ATG with cyclosporine.
2. Kahl C, Leisenring W, Deeg HJ, et al. Cyclophosphamide and antithymocyte globulin as a conditioning regimen for allogeneic marrow transplantation in patients with aplastic anaemia: a long-term follow-up. Br J Haematol 2005;130:747–51.
5. Frickhofen N, Heimpel H, Kaltwasser JP, Schrezenmeier H. Antithymocyte globulin with or without cyclosporin A: 11-year follow-up of a randomized trial comparing treatments of aplastic anemia. Blood 2003;101:1236–42
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