Author/Editor     Černelč, P
Title     Zdravljenje lahke oblike aplastične anemije s ciklosporinom
Translated title     Treatment of non-severe aplastic anemia with cyclosporin
Type     članek
Source     Zdrav Vestn
Vol. and No.     Letnik 64, št. 10
Publication year     1995
Volume     str. 551-3
Language     slo
Abstract     Background. The author presents treatment of non-severe aplastic anemia (AA) with glucocorticosteroids and cyclosporin (Sandimmun Neoral, Sandoz Pharma). AA is a rare disease due to injury of a pluripotential stem cell. Mild forms of the disease can be treated with antilymphocyte globulin, cyclosporin or a combination of both agents. Results. A 37 year old woman who developed non-severe aplastic anemia after childbirth was successfully managed with glucocorticoids given for 13 years with periodic breaks. Because of aseptic necrosis of the femoral head glucocorticosteroids had to be discontinued and the patient was placed on oral cyclosporin 10 mg/kgBW daily. During the first week of therapy, cyclosporin blood levels ranged from 308 to 355 microg/L, so that the daily dose was gradually reduced to 300 mg. As during the first week of therapy, the patient's condition kept deteriorating, blood transfusion was administered. After2 weeks herplatelet count returned to normal and after 11 weeks reticulocytes began to increase. As the patients hemoglobin level was about 114 g/L throughout the treatment. cyclosporins were discontinued after 13 weeks. Conclusions. In the past patients with non-severe aplastic anemia were used to be treated with androgenic steroids or low-dose glucocorticoids, but recently the therapy has hben replaced by, antilymphocytic globulin and/or cyclosporin. Treatment with Sandimmun Neoral has proved to be effective in most cases. It is also it is associated with lower complication rates than therapy with androgenic steroids or glucocorticoids.
Summary     Izhodišča. Avtor opisuje zdravljenje lahke oblike aplastične anemije (AA) z glukokortikoidi in ciklosporinom (Sandimmun Neoral, Sandoz Pharma). Aplastična anemija je redka bolezen, ki je posledica okvare pluripotentne matične celice. Lahko obliko bolezni lahko zdravimo s protilimfocitnim globulinom, ciklosporinom ali pa kombinacijo obeh. Rezultati. 37 letno bolnico z lahko obliko aplastične anemije, ki se je pojavila pri porodu, smo 13 let v presledkih uspešno zdravili z glukokortikoidi. Zaradi aseptične nekroze glavice stegnenice smo zdravljenje z glukokortikoidi prenehali in začeli s ciklosporinom v kapsulah 10 mg/kg telesne teže na dan. V prvem tednu zdravljenja je bila koncentracija ciklosporina v krvi 308-355 microg/L, zato smo dnevni odmerek zdravila v naslednjih dneh zmanjšali na 300 mg. Prvi teden zdravljenja se je anemija še poslabšala, zato je bolnica prejela transfuzijo krvi. Po dveh tednih zdravljenja se je zvečalo število trombocitov na normalno vrednost, po 11 tednih zdravjenja pa se je postopno zvečalo število retikulocitov. Koncentracija hemoglobina je bila ves čas okoli 114 g/L, zato smo zdravljenje s ciklosporinom po 13 tednih prenehali. Zaključki. Lahko obliko AA smo pred leti zdravili z androgenimi steroidi ali odmerki glukokortikoidov, sedaj pa uporabljamo protilimfocitni globulin in/ali ciklosporin. Zdravljenje s Sandimmun Neoralom je pogosto učinkovito, običajno ga spremlja manj zapletov kot zdravljenje z androgenimi steroidi in glukokortikoidi.
Descriptors     ANEMIA, APLASTIC
CYCLOSPORINE
GLUCOCORTICOIDS