Clinical study on haploidentical hematopoietic stem cell transplantation for children with bone marrow failure syndromes / 中华实用儿科临床杂志

Objective:To explore the efficacy of haploidentical hematopoietic stem cell transplantation (haplo-HSC) combined with tpCB in the treatment of children with bone marrow failure syndromes (BMFs).Methods:The clinical chara-cteristics of 78 BMFs pediatric patients, including inherited BMFs (4 cases) and acquired BMFs (74 cases) under-went haplo-HSC combined with the third-party cord blood (tpCB) in Chinese People′s Liberation Army General Hospital-Sixth Medical Center between July 2012 and July 2019 and were retrospectively analyzed, with 41 males and 37 females.Among them, 73 cases experienced first transplantation and 5 cases accepted second transplantation, with the median age of 5.6 years.The conditioning regimen was based on Busulfan, with 74 acquired BMFs cases using non-myeloablative and the remaining 4 cases using myeloablative.The prophylaxis of acute graft versus host disease (aGVHD) includes Cyclosporine, Mycophenolate mofetil (MMF) and Methotrexate.All patients received bone marrow from haploid donor and tpCB on day 1 and peripheral stem cell from haploid donor on day 2.The median dose of the total donor nucleated cells was 12.19×10 8/kg of recipient weight and CD 34+ cell dose was 6.13×10 6/kg of recipient weight. Results:The median time of granulocytes over 0.5×10 9/L and platelets over 20×10 9/L were + 13 d and + 17 d, respectively.All patients displayed complete donor-type chimerism at + 30 d. No primary graft failure occurred in any patient and second graft failure occurred in two cases.The incidence rate of grade ⅡtoⅣ and grade Ⅲ to Ⅳ aGVHD were 39.0% and 13.9%, respectively.The incidence of chronic GVHD with limited type and extensive type were 7.8% (95% CI: 7.1%-8.5%) and 2.6% (95% CI: 2.1%-3.1%), respectively.the median follow-up was 1 550 days, and 76 patients survived with free disease.The rate of transplant related mortality was 2.8%, and both of the estimated 5-year overall survival and failure-free survival rate were 97.2%(95% CI: 96.8%-97.6%). Conclusions:Haplo-HSC and umbilical cord blood can quickly provide hematopoietic stem cells.The results of haplo-HSC combined with the tpCB in pediatric patients with life-threatening BMFs are promising.

Clinical analysis of red blood cell transfusion in patients with bone marrow failure / 中国输血杂志

【Objective】 To explore the clinical factors affecting the efficacy of red blood cell (RBC) transfusion in patients with bone marrow failure diseases (BMFD). 【Methods】 81 patients with BMFD admitted to our hospital from June, 2012 to May, 2020 were analyzed retrospectively. Hemoglobin (Hb) was used as quantitative judgment basis, and multiple stepwise regression analysis was used to screen out various factors affecting the efficacy of red blood cell transfusion. 【Results】 229 occasions of RBC transfusion were performed in 81 patients, and 129 refractory transfusions occurred, accounting for 51.97%. The clinical effect of RBC transfusion is related to hemorrhage, hepatosplenomegaly, infection, blood transfusion frequency, anemia degree and BSA. Multiple stepwise regression analysis showed that infection, hemorrhage and blood transfusion frequency are important factors affecting the infusion effect. 【Conclusion】 The efficacy of RBC transfusion in BMFD patients is affected by various clinical factors. Clinicians should personalize the infusion strategy, so as to improve the transfusion efficacy by reducing the transfusion frequency, and bleeding as well as avoiding the transfusion during fever.

Desenlace de los pacientes pediátricos con falla medular tratados en un centro de alta complejidad / Outcomes in pediatrics patients diagnosed with bone marrow failure disorders treated in a tertiary care center

INTRODUCCIÓN: Los síndromes de falla medular (SFM) son trastornos infrecuentes, con una incidencia anual de 2-4 casos por millón. Las opciones de tratamiento incluyen terapia de inmunosupresión (TIS) y restaura ción de la hematopoyesis con trasplante de progenitores hematopoyéticas (TPH). OBJETIVO: Analizar los desenlaces de pacientes pediátricos diagnosticados con SFM tratados en una institución de alta complejidad. PACIENTES Y MÉTODO: Estudio retrospectivo de pacientes pediátricos con diagnóstico de SFM que consultaron a la Fundación Valle del Lili, Cali. Se realizo análisis estadístico descriptivo según SFM adquirida (SFMA) y SFM congénita (SFMC). Los desenlaces incluyeron: tratamiento, complicaciones, supervivencia global (SG) en los trasplantados, calculada con el método Kaplan Meier. RESULTADOS: Se incluyeron 24 pacientes con SFM, edad 6,5 ± 4 años, 50% mujeres. El 58% fue ron SFMC, 9 con anemia de Fanconi, 2 disqueratosis congénita, 2 trombocitopenia amegacariocítica congénita, uno anemia Diamond-Blackfan. Doce pacientes con TPH tuvieron SG a 5 años de 83%. SFMA correspondió al 42%, 6 recibieron TIS-TPH, 3 TIS y 1 TPH, la SG del grupo con TIS-TPH fue 86%. Seis pacientes fallecieron, 4/6 relacionadas con infección. CONCLUSIONES: En esta serie fue mayor el número de casos con SFMC. La SG de los pacientes llevados a TPH es comparable con la reportada en estudios recientes. La causa de muerte predominante fue infecciosa que también se ha reportado previamente. El tratamiento instaurado en los pacientes de esta serie mostró resultados favorables en un centro de alta complejidad en un país latinoamericano.

INTRODUCTION: Bone marrow failure (BMF) syndromes are rare disorders with an annual incidence of 2-4 cases per million. Treatment options include immunosuppressive therapy (IST) and hematopoietic stem cell transplantation (HSCT). OBJECTIVE: To analyze the outcomes of pediatric patients diagnosed with BMF treated in a tertiary care center. PATIENTS AND METHODP: Retrospective study of pediatric patients diagnosed with BMF who consulted at Fundación Valle de Lili, Cali. Descriptive statistical analysis was performed according to Acquired BMF (ABMF) and Inherited BMF (IBMF). The outcomes include treatment, complications, overall survival (OS) in transplant patients, calculated using the Kaplan Meier method. RESULTS: We included 24 patients with BMF, average age 6.5 ± 4 years, and 50% were women. 58% presented IBMF, 9 with Fanconi anemia (FA), 2 dyskeratosis congenita, 2 congenital amegakaryocytic thrombocytopenia, and 1 presented Diamond-Blackfan anemia. 12 patients treated with HSCT had a 5-year OS of 83%. ABMF represented 42%. 6 patients received IST-HSCT, 3 received IST, and 1 received HSCT. The OS of the IST-HSCT group was 86%. Six patients died, four of them related to infection. CONCLUSIONS: In this series, there was a higher number of cases with IBMF. The OS of patients treated with HSCT is similar to that reported in recent studies. The most frequent cause of death was of infectious origin which has also been previously reported. The treatment esta blished in the patients showed favorable results in a Latin American tertiary care center.

Osteopetrosis infantil maligna / Malignant Infantile osteopetrosis

INTRODUCCIÓN: Osteopetrosis Infantil Maligna (OIM) es un grave e inusual desorden genético debi do a una actividad osteoclástica anormal. OBJETIVO: Reportar lactante en quien se documentó una Osteopetrosis Infantil Maligna, revisando aspectos diagnósticos y terapéuticos más relevantes. CASO CLÍNICO: Reportamos un lactante de 10 meses de sexo masculino en quien se confirmó OIM tras presentar plaquetopenia y visceromegalias. En su historial destacó ser primer hijo de padres no consanguíneos, y entre sus hallazgos presentó hepatoesplenomegalia, plaquetopenia y anemia graves, compromiso sensorial visual y auditivo e infecciones a repetición. El diagnóstico fue confirmado mediante estudio genético, el cual identificó 2 mutaciones heterocigotas en el gen TCIRG1. Se rea lizó trasplante de precursores hematopoyéticos, sin haber presentado recuperación hematológica, falleciendo por enfermedad veno oclusiva. DISCUSIÓN: La OIM es una enfermedad inusual, grave y de inicio temprano, siendo necesario un elevado índice de sospecha ante hepatoesplenomegalia y falla medular. El diagnóstico temprano y el trasplante de precursores hematopoyéticos son las únicas intervenciones potencialmente curativas de esta entidad letal.

INTRODUCCIÓN: Malignant Infantile Osteopetrosis (MIOP) is a rare and severe genetic disorder due to abnormal osteoclast activity. OBJECTIVE: To report an infant who presented Malignant Infantile Osteopetrosis, reviewing the most relevant diagnostic and therapeutic aspects. CLINICAL CASE: A ten- month-old male infant with diagnosis of MIOP confirmed after presenting thrombocytopenia and visceromegaly. He was the first child of non-consanguineous parents, and among the findings, he presented severe hepatosplenomegaly, thrombocytopenia, and anemia; visual and hearing impairment, and repeated infections. The diagnosis was confirmed by genetic study, which identified two heterozygous mutations in the TCIRG1 gene. Hematopoietic stem cells were transplanted without hematological recovery. The patient died due to occlusive venous disease. DISCUSSION: MIOP is a rare, severe, and early-onset disease, with a high rate of suspicion necessary in the presence of hepatosplenomegaly and bone marrow failure. Early diagnosis and hematopoietic stem cells transplanta tion are the only potentially therapeutic interventions of this lethal entity.

Clonal evolution and clinical significance of trisomy 8 in acquired bone marrow failure / 中华血液学杂志

Objective@#To analyze clonal evolution and clinical significance of trisomy 8 in patients with acquired bone marrow failure.@*Methods@#The clinical data of 63 patients with acquired bone marrow failure accompanied with isolated trisomy 8 (+8) from June 2011 to September 2018 were analyzed retrospectively, the clonal evolution patterns and relationship with immmunosuppressive therapy were summarized.@*Results@#Totally 24 male and 39 female patients were enrolled, including 39 patients with aplastic anemia (AA) and 24 patients with relatively low-risk myelodysplastic syndrome (MDS) . Mean size of+8 clone in MDS patients[65% (15%-100%) ]was higher than that of AA patients[25% (4.8%-100%) , z=3.48, P=0.001]. The patients were was divided into three groups (<30%, 30%-<50%,and ≥50%) according to the proportion of+8 clone. There was significant difference among the three groups between AA[<30%:55.6% (20/36) ; 30-50%: 22.2% (8/36) ; ≥50%22.2% (8/36) ]and MDS patients[<30%:19.0% (4/21) ; 30%-<50%:19.0% (4/21) ; ≥50%61.9% (13/21) ] (P=0.007) . The proportion of AA patients with+8 clone <30% was significantly higher than that of MDS patients (P=0.002) ; and the proportion of AA patients with+8 clone ≥50%was significantly lower than that of MDS patients (P=0.002) . The median age of AA and MDS patients was respectively 28 (7-61) years old and 48.5 (16-72) years old. Moreover, there was no correlation between age and+8 clone size in AA or MDS (rs=0.109, P=0.125; rs=-0.022, P=0.924, respectively) . There was statistical difference in total iron binding capacity, transferrin and erythropoietin between high and low clone group of AA patients (P=0.016, P=0.046, P=0.012, respectively) , but no significant difference in MDS patients. The immunosuppressive therapy (IST) efficacy of AA and MDS patients was respectively 66.7% and 43.8% (P=0.125) . Comparing with initial clone size (27.3%) , the +8 clone size (45%) of AA patients was increased 1-2 year after IST, but no statistical difference (z=0.83, P=0.272) . Consistently, there was no significant change between initial clone size (72.5%) and 1-2 year clone size (70.5%) after IST in MDS patients. There was no significant difference in IST efficient rate between +8 clone size expansion and decline group of in AA patients at 0.5-<1, 1-2 and>2 years after IST. We found four dynamic evolution patterns of +8 clone, which were clone persistence (45%) , clone disappearance (30%) , clone emergence (10%) and clone recurrence (15%) .@*Conclusions@#AA patients had a low clone burden, while MDS patients had a high burden of +8 clone. The +8 clone of AA patients didn’t significantly expanded after IST, and the changes of +8 clone also had no effect on IST response.

Research progress of dyskeratosis congenita / 中华口腔医学杂志

Dyskeratosis congenita (DC) is a rare disease and a genetic heterogeneity of bone marrow failure, characterized by muco-cutaneous triad of mucosal leukoplakia, abnormal skin pigmentation, nails dystrophy and often involving multiple organs or systems. The inheritance patterns of DC include X-linked recessive, autosomal dominant and recessive patterns. However, the inheritance patterns in 30%-40% of DC patients remained unknown. Dyskeratosis congenita is difficult to diagnose because of its genetic and clinical heterogeneity. This article will review and discuss the state-of-the-art progresses in genetics, clinical manifestation, diagnosis, differential diagnosis, treatment and prognosis of DC.

Tetramethylpyrazine promotes bone marrow repair in a C57 mouse model of X-rayinduced immune-mediated bone marrow failure / 南方医科大学学报

OBJECTIVE@#To observe the therapeutic effect of tetramethylpyrazine on immune-mediated bone marrow failure (BMF) induced by different doses of X-ray exposure in C57 mice.@*METHODS@#C57BL6 mice were randomized into 4 groups, including a blank control group and 3 X-ray exposure groups with X-ray exposure at low (5.0 Gy), moderate (5.75 Gy), and high (6.5 Gy) doses. After total body irradiation with 0.98 Gy/min X-ray. The mice as recipient received injections of 4×10 lymphocytes from DBA/2 mice via the tail vein within 4 h. The survival rate of the recipient mice, peripheral blood cell counts, bone marrow nucleated cell count, and bone marrow pathology were examined at 14 days after the exposure. In the subsequent experiment, C57 mice were exposed to 5.0 Gy X-ray and treated with intraperitoneal injection of tetramethylpyrazine at the low (5 mg/mL), moderate (10 mg/mL), or high (20 mg/mL) doses (12 mice in each group) for 14 consecutive days, and the changes in BMF were observed.@*RESULTS@#X-ray exposure, especially at the high dose, resulted in significantly lowered survival rate in the mouse models of BMF at 14 days. As the X-ray dose increased, the mice showed significantly reduced peripheral blood counts of red blood cells, white blood cells, platelets and lowered bone marrow nucleated cell counts with obvious bone marrow congestion and reduction of nucleated cells ( < 0.05 or 0.001). In the mice exposed to 5.0 Gy X-ray, tetramethylpyrazine at the high dose most obviously increased bone marrow nucleated cells ( < 0.01) and red blood cells ( < 0.001), and even at the low dose, tetramethylpyrazine significantly increased the counts of white blood cells ( < 0.05) and platelets ( < 0.01) following the exposure. Tetramethylpyrazine dose-dependently alleviated bone marrow hyperemia, increased bone marrow nucleated cell counts, and lowered Fas protein expression in the bone marrow.@*CONCLUSIONS@#X-ray irradiation at 5.0 Gy is suitable for establish mouse models of immune-mediated BMF. Tetramethylpyrazine promotes bone marrow repair by regulating Fas cell apoptosis signals, which further expands the traditional Chinese medicine theory of "removing blood stasis to create new."

Effect of tetramethylpyrazine on renal oxidative stress in immune-mediated bone marrow failure mice / 中国药理学通报

; A i m To explore the effects of tetramethylpyrazine (T M P) on renal oxidative stress in immune-mediated bone marrow failure (B M F) C57 mice. Methods C57 mice were randomly divided into normal control group, total body irradiation group (T B I), model group, TMP low dose group (5 g • L " 1), T M P medium dose group (10 g • L " 1), and T M P high dose group (2 0 g • L " 1) . The B M F model was established by total body irradiation with 5. 0 Gy X-ray and l y m - phocyte infusion. The peripheral blood triline cells, bone marrow nucleated cells, bone marrow pathology, kidney pathology and oxidative stress indexes were observed 14 days later. Results Bone marrow pathology of the model group showed that the bone marrow nucleated cells decreased and the peripheral blood triline cells decreased significantly, indicating that the i m - mune-mediated B M F model was successfully established. Renal pathology of model group showed tubular edema, and the oxidative stress index M DA increased, and the antioxidant stress indicators GSH, SOD, GSHPx decreased, indicating that there was renal oxidative stress damage in BMF mice. After treatment with TMP, there was no obvious abnormality in renal pathology, the oxidative stress index MDA of the kidney decreased and the antioxidant stress index GSH, SOD increased. Immunohistochemistry showed that the expression of HIF-1 a decreased and VEGF existence was observed. Conclusions TMP can alleviate renal oxidative stress injury in immune-mediated BMF mice, which may be related to the regulation of HIF-1 oc/ VEGF expression.

Progress of Shwachman-Diamond syndrome / 中华实用儿科临床杂志

Shwachman - Diamond syndrome (SDS)is a rare autosomal recessive disorder,SDS is characte-rized by exocrine pancreatic dysfunction,bone marrow failure,skeletal abnormalities and various other organ dysfunc-tions,and predisposition to MDS and acute myelogenous ceukemia. The Shwachman - Bodian - Diamond syndrome (SBDS)gene located on chromosome 7q11,the common mutation type is 183_184 TA > CT and 258 + 2 T > C. The purpose of this document is to comprehensive analysis the relevant literatures,analyze its clinical characteristics,geno-type,diagnosis and treatment suggestions to improve the clinician knowledge of the disease.

Aplastic anemia and clonal evolution:germline and somatic genetics / 白血病·淋巴瘤

Clonal progression to myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) remains a dreaded complication for a subset of patients with bone marrow failure (BMF). Recognizing risk factors for the development of MDS or AML would inform individualized treatment decisions and identify patients who may benefit from early or upfront hematopoietic stem cell transplantation. Now that next-generation DNA sequencing is available in the clinical laboratory, research has focused on the implications of germline and somatic mutations for diagnosing and monitoring patients with BMF. Most germline genetic BMF disorders are characterized by a high propensity to develop MDS or AML. Recent studies of somatic variants in marrow failure revealed a high frequency of clonal hematopoiesis with the acquisition of mutations in genes associated with MDS or AML. The evaluation and implications of germline and somatic mutations for the development of clonal disorders in patients with BMF and challenges of clinical genetic testing will be summarized in this paper based on the reports from the 58th American Society of Hematology (ASH) Annual Meeting.

Progress of inherited bone marrow failure syndromes / 国际儿科学杂志

Inherited bone marrow failure syndromes are a group of congenital diseases.Their pathogenesis are not entirely clear.The causative genes have been found in part of the diseases, and we have preliminarily mastered their diagnosis and treatment.The diagnosis is mostly based on typical clinical manifestations and related laboratory tests.Along with the genetic testing developmenff,genetic testing has become the main method to diagnose IBMFS.Hematopoietic stem cell transplantation is currently the only way to cure these diseases.Support and symptomatic treatment also play an important role in terms of delaying and improving the condition.Gene therapy is still not mature, and other treatments are constantly being explored.

Treatment of umbilical cord blood transplantation in pediatric rare diseases / 中华实用儿科临床杂志

Rare diseases are very rare,but usually have severe symptoms.Some rare diseases are life-threatening.Most rare diseases cannot be cured.A very small part of these diseases can be cured by hematopoietic stem cell transplantation (HSCT).Umbilical cord blood transplantation(UCBT) is more suitable for children for the weak T cell immunity,the lower request for human leukocyte antigen (HLA) identity type and the lower incidence of graft versus host disease(GVHD).This article reviewed the published data in the treatment of UCBT in primary immunodeficiency disease,inherited metabolic disease,inflammatory bowel disease and bone marrow failure syndrome,in order to improve the level of rare disease treatment by HSCT,especially for UCBT.

Current insights into inherited bone marrow failure syndromes / 소아과

Inherited bone marrow failure syndrome (IBMFS) encompasses a heterogeneous and complex group of genetic disorders characterized by physical malformations, insufficient blood cell production, and increased risk of malignancies. They often have substantial phenotype overlap, and therefore, genotyping is often a critical means of establishing a diagnosis. Current advances in the field of IBMFSs have identified multiple genes associated with IBMFSs and their pathways: genes involved in ribosome biogenesis, such as those associated with Diamond-Blackfan anemia and Shwachman-Diamond syndrome; genes involved in telomere maintenance, such as dyskeratosis congenita genes; genes encoding neutrophil elastase or neutrophil adhesion and mobility associated with severe congenital neutropenia; and genes involved in DNA recombination repair, such as those associated with Fanconi anemia. Early and adequate genetic diagnosis is required for proper management and follow-up in clinical practice. Recent advances using new molecular technologies, including next generation sequencing (NGS), have helped identify new candidate genes associated with the development of bone marrow failure. Targeted NGS using panels of large numbers of genes is rapidly gaining potential for use as a cost-effective diagnostic tool for the identification of mutations in newly diagnosed patients. In this review, we have described recent insights into IBMFS and how they are advancing our understanding of the disease's pathophysiology; we have also discussed the possible implications they will have in clinical practice for Korean patients.

Association of killer cell immunoglobin-like receptor gene with bone marrow failure syndromes / 中华微生物学和免疫学杂志

Objective To investigate the correlation of killer immunoglobulin-like receptors(KIR)gene polymorphism with bone marrow failure syndromes(BMFS). Methods SSP-PCR was used to examine the genotypic makeup of KIR in patients with aplastic anemia( AA), myelodysplatic syndrome (MDS) and healthy controls in our department. Results All the 16 KIR genes which had been prescribed were identified. The frequencies of KIR-2DS1, 2DS2, 2DS3, 2DS5 and 3DS1 genes were showed increased in patients with AA, MDS than in healthy controls. The patients with AA had lower frequency of KIR-2DS5 than the patients with MDS. Conclusion The increased frequencies of these activated KiRs in patients with MDS and AA suggest that the abnormal immunogenetic might be related to the pathogenesis of BMFS.

Prospect of treatment of essential bone marrow failure by the immunosuppression

There were 39 aplastic anemia patients with immunopathology, who was treated by immunosuppresion such as: Spleenectomy, thymus transplantation using cyclosporine A. The results show that: immunosuppression has successful rate of 50-60% in aplastic anemia after internal treatment was not effectiveness.

Differentiation and therapy of idiopathic bone marrow failure anemia / 中国实用内科杂志

Idiopathic bone marrow failure anemia(BMF),a group of severe hematopoietic diseases including acquired aplastic anemia,pure red cell aplasia,immune related pancytopenia,immune related anemia,paroxysmal nocturnal hemogobinurea,myelodysplastic syndromes and idiopathic cytopenia of undetermined significances,is quite easy to be misdiagnosed clinically.The proper diagnoses of these diseases should be made on the complete and detailed information about the patient's symptoms and signs,results of regular blood tests,bone marrow morphology examination and investigations on the pathogenesis of BMF,and response to the tentative therapy if it is necessary.High curative rate of these diseases will be achieved with prompt and long enough therapies for supporting patient's life,blocking the pathogenic process and stimulating hematopoiesis.

Immunological disorder in patients with acquired bone marrow failure with unknown causes

The study was carried out in 65 aplastic anemia patients admitted into B¹ch Mai hospital during the period 1995-1999 on the issues of immunological characteristics. The results can be summarized as follows: The count of lymphocytes and the majority of sub-groups of lymphocytes were decreased compared with the control group (p<0.05 - 0.01). The TCD4/TCD8 ratio is decrease compared with the control group. The level of IgG in plasma increased. In the bone marrow, the count of subgroup of lymphocytes decreased compared with the control group. Comparing between peripheral blood and bone marrow, it can be seen that the percentage of T lymphocytes and its sub-groups decreased significantly. The change of the percentage of B lymphocytes however, it is not significant.

Some heamatological features of the bone marrow failure

We had drawn out some following remarks from the our studied group of patients with bone marrow failure; - There are 89.29% patients with bone marrow failure in three blood cell lineages; and 35.71% of the patients is servere aplastic anemia. - 14.29% patients with bone marrow failure were finished in the diagnosis of acute leukemia(M1= 50%, M2= 50%). - The persentages of the patients with bone marrow failure died from infection (37.5%) and hemorrhage (50.0%) are still high. Almost of the patients were died in the stage from 24 months to 48 months after having the diagnosis.

Clinical and epidemiological features of bone marrow failure

From 26 patients with bone marrow failure, we had drawn some following remarks:- Over 50% of the patients is in the ages from 61 to 75 years old. (youngest: 42: oldest: 82 years old).- There were 38.46% of the patients that were used to contact with some causes of AA in their history particalarly 11.54%- using cloramphenicol; and 7.69% used to live in the area with American orange toxicant. - 100% of the patient with anemia; 15.36% with anemia + hemorrhage; then anemia + infection (7.69%) and anemia + hemorrahage + infection(7.69%).

Treatment of the bone marrow failure in the Ho Chi Minh center for hematology and blood transfusion

From 1990 to 2000, 513 cases of aplastic anemia were diagnosed and treated in Blood transfusion and Hematology Centre of Ho Chi Minh city, composing of 144 children and 369 adults with 279 males and 234 females. By bone marrow aspiration and biopsy, we diagnosed these cases as follow: aplastic anemia 449 cases (87.5%), hypocellularity of bone marrow: 45 (8.8%), one lignea hypocellularity of bone marrow: 19 (3.7%). From these cases, we have found that: - ’s difficult to point out accurately the cause of aplastic anemia and this is still the question for many studies in future. - All the patient was treated mainly blood transfusion, corticoid and androgen (77.5%) with complete and partial response was 25.5%. Besides, 32 cases were treated with corticoid + Sandimum given better results with complete response (32.7%).