High dose intravenous glucocorticoid in the treatment of childhood acquired aplastic anaemia

Abstract

31 children with acute acquired aplastic anaemia were treated with very high doses of i.v. bolus methylprednisolone. In 3 of them, paroxysmal nocturnal haemoglobinuria was diagnosed. Therefore the responses of 28 patients have been evaluated. Normoblastaemia and reticulocytes were observed on about the 6th d and leucocyte and granulocyte response around the 11th d of treatment. The first haemoglobin (greater than or equal to 0.5 g/dl) and haematocrit elevations were documented on about the 16th d and the initial platelet response (average greater than or equal to 34 X 10(9)/l) took more than a month. At least 64% of the patients responded to this treatment including 2 cases in whom aplasia was observed following hepatitis. Although 10 episodes of recurrences occurred in 8 patients (with the exception of 3 patients' in whom 5 recurrences were observed), response to the same regimen was obtained. With 1 exception the side-effects of this treatment could be managed by decreasing the dose. With this treatment, acquired aplastic anaemia should no longer be considered a fatal disease, at least in children.