Objective To assess the clinical effectiveness and safety of astragalus injection plus androgen versus androgen alone for patients with aplastic anemia (AA). Methods Such databases as The Cochrane Library (Issue 3, 2011), PubMed (1966 to March 2011), EMbase (1974 to March 2011), CNKI (1994 to March 2011), VIP (1989 to March 2011) and Wanfang Data (1997 to March 2011) were searched to include the randomized controlled trails (RCTs) according to the inclusive and exclusive criteria. The data were extracted, the quality was assessed, and meta-analysis was conducted by using Revman5.0.24 software. Results Seven RCTs involving 518 patients with AA were included. The meta-analysis showed that the astragalus plus androgen treatment group was superior to the androgen alone group in the total effective rate with significant difference (OR=3.12, 95%CI 2.09 to 4.66, Plt;0.000 01); the adverse events in the treatment group were fewer than those in the control group with significant difference (OR=0.30, 95%CI 0.12 to 0.76, P=0.01); but the promotion degree of myelosis between the two groups was similar without significant difference (OR=1.93, 95%CI 0.85 to 4.38, P=0.11). Conclusion The astragalus plus androgen treatment is superior to the androgen alone treatment in the total effective rate and fewer adverse events. More high-quality trails are required to verify this conclusion due to the low quality and small scale of the included studies.
We reported one case of MTX-induced aplastic anemia and reviewed related literature to investigate the mechanism of action of MTX, and summarize the clinical feature, diagnostic criteria, risk factor, and interventions. These were hoped to arouse the attention of clinicians and clinical pharmacists, in order to effectively prevent, diagnose, and treat MTX-induced aplastic anemia.
Objective To assess the effectiveness and safety of cyclosporine A (CsA) for aplastic anemia (AA) in China. Methods Randomized controlled trails (RCTs) of CsA for AA were collected from CBMdisc (1978 to 2008), CNKI (1979 to 2008), and VIP (1989 to 2008). Other relevant journals were also hand searched. The methodological quality of included studies was evaluated, and data analyses were performed with The Cochrane Collaboration’s software RevMan 4.2.0. Results A total of 19 RCTs were included. As for the total effective rate and complete remission rate, significant differences were noted between CsA + androgen vs. androgen alone, CsA + androgen combination vs. androgen combination, as well as CsA + androgen + other drugs vs. androgen + other drugs [total effective rate: RRs and 95%CIs were 1.48 (1.28 to 1.70), 1.67 (1.17 to 2.39), and 1.51 (1.09 to 2.08); complete remission rate: RRs and 95%CIs were 2.06 (1.33 to 3.19), 3.52 (1.19 to 10.39), and 1.54 (1.00 to 2.38)]. Conclusion According to the domestic evidence, treatment with CsA for AA may improve the total effective rate and complete remission rate. However, more high quality clinical trials are expected for further study.
Objective To asses the clinical effectiveness and safety of combined treatment with antilymphocyte globulin (ATG) and cyclosporine A (CSA) versus antilymphocyte globulin alone in patients with aplastic anemia (AA). Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1966 to September 2007), EMBASE (1984 to September 2007), The Cochrane Library (issue 4, 2007) and CBM-disc (1978 to September 2007). The references of eligible studies were hand searched. RCTs involving ATG and CSA in the treatment of AA were included. Data were evaluated and extracted by two reviewers independently with designed extraction form. The Cochrane Collaboration’ s RevMan 4.2.10 software was used for data analyses. Results Two RCTs involving 160 patients were included. Two studies showed that the effective rate in the ATG+CSA group was significantly higher than that in the ATG group (Plt;0.0001). Two studies indicated that the survival rate in the ATG+CSA group was improved compared with the ATG group (P=0.0002). One study reported adverse effect. The ATG group caused more fever and serum diseases compared with the ATG+CSA group, but the ATG+CSA group had a higher incidence of hepatotoxicity. Conclusion Treatment with ATG+CSA for aplastic anemia has higher effective rate and survival rate than ATG alone. More trials of high quality are required.
ObjectiveTo investigate the diagnosis, clinical features, treatment and outcome of pure red cell aplasia (PRCA) caused by human parvovirus B19 (HPV-B19) infection in kidney recipients. Method The clinical courses of six patients with PRCA caused by HPV-B19 infection after renal transplantation in West China Hospital between May 2018 and April 2019 were retrospectively investigated. Results The six patients showed obvious anemia symptoms, lacking rash, joint pain and other clinical symptoms of viral infection. The hemoglobin level of five patients got totally remission from a course of intravenous immunoglobulin (IVIG) treatment, and anemia symptoms like fatigue, weakness got notable improvement. One patient had no improvement after two courses of IVIG treatment, and his anemia was significantly improved after the third IVIG course combined with immunosuppressant conversion(from tacrolimus to cyclosporine), and one patient with recurrence accepted a repeated course of IVIG treatment and obtained remission of severe anemia again. The median time of reticulocyte firstly rose to above 0.084×1012/L from the day of IVIG treatment ended was 3.50 (1.25, 5.00) days, and the median time required for a 30 g/L increase in hemoglobin to the end of IVIG treatment was 16.00 (9.25, 31.25) days. No serious adverse reactions occurred and all patients had stable graft function. Conclusions The main clinical manifestations of PRCA caused by HPV-B19 infection after kidney transplantation are anemia symptoms, lacking other clinical symptoms of viral infection. HPV-B19 DNA detection combined with blood routine examination, reticulocyte count and bone marrow cytology (or none) can diagnose HPV-B19 infection. High dose of IVIG is effective and safe, and a repeated course is still effective when the infection recurs. For refractory PRCA that IVIG monotherapy fail, a combination with conversion from tacrolimus to cyclosporine can effectively improve the anemia without graft dysfunction.