ABSTRACT
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. Theorically, 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 ramaining 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 chronica AA; 12 without previous treatment and two treated before with antilymphocyte globulin + oxymetholone (OXN) + cyclosporine A (CsA) with transiet partial remission (PR). Besides lymphocytapheresis, 13 patients received OXM; 4 of them GM-CSF ad 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 cocnlusion, 14 (60.8 perecent) of 23 patients with AA showed an improvement related to LC treatment, with a survival probability of 63 percent from the fourth month, the latter with and 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
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Anemia, Aplastic/therapy , Autoimmune Diseases/therapy , Lymphocyte Depletion/methods , Leukapheresis , T-Lymphocyte SubsetsABSTRACT
El presente trabajo describe los resultados del procedimiento empleado para obtener los injertos de médula ósea (MO) administrados a enfermos con anemia aplástica grave. En los años de 1980 a 1984, se realizaron en el Hospital General del C.M.N. del IMSS, cuatro aspiraciones múltiples de la MO en tres donadores sanos, hermanos con antígeno de histocompatibilidad (HLA) compatibles de los pacientes. Para tal fin se utilizó la técnica descrita por Thomas y Storb en 1970 la que permitió obtener sin reacciones indeseables, ni modificaciones en los índices hematológicos en la sangre periférica de los donadores, un número suficiente de células nucleadas para el trasplante. En dos enfermos el Injerto prendió y sólo en uno se observó el rechazo del injerto en dos ocasiones sucesivas lo que ocurrió al parecer por un mecanismo inmunología). Se refiere detalladamente el procedimiento empleado y se discuten los factores que modifican su rendimiento; finalmente, se consideran las condiciones que contribuyen a mejorar los resultados del trasplante de médula ósea.