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KMID : 0882419930440030380
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Korean Journal of Medicine
1993 Volume.44 No. 3 p.380 ~ p.389
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A Clinical Observation on Aplastic Anemia
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길준영
전의건/윤환중/김백수/최용석/조덕연/김삼용
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Abstract
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ackgound : It is well known that aplastic anemia is more prevalent in the Far East than
elsewhere in the world. There have been many suggestions that the clinical features of the
patients with aplastic anemia in Korea would be somewhat different from tht of western
countries. Analysis of clinical data of 32 cases of aplastic anemia diagnosed at Chungnam
National University Hospital from August 1985 to July 1991 was done.
Methods : Initially all patients were treated with oxymetholone (50-100 mg/d) with or
without prednisolone (5-10 mg/d) and supportive care. The patients who did not respond to
androgen therapy were treated with antilymphocyte globulin (ALG) (20 mg/kg/d for 4 days)
plus methylprednisolone (methyl PD) (20 mg/kg/d for 5 days). Analysis of reponse to
therapy was done in 31 patients who could be followed for more than 3 months.
Results : 12 patients (37.5%) were in their third decade and 25 cases of patients (78.2%)
were below 40 years of age. The incidence decreased in older age groups. Exposure to
possible toxic agents were seen in 6 cases (18.8%); benzene was counted in 2 cases (6.3%),
herb drug in 2 cases (6.3%), antifungal agent in 1 case (3.1%). One case of aplastic anemia
occurred after acute viral hepatitis infection (type B) (3.1%). Eleven (35.5%) out of thiry-one
patients responded to androgen therapy (CR:16.1%, PR:19.4%). Nine out of the twenty
patients who did not respond to androgen therapy were treated with ALG plus methyl PD.
Two patients (22.2%) out of 9 showed complete responses. Overall response of present series
of patients was 42% (oxymetholone±prednisolone therapy :35.5%, ALG+methyl PD:22.2%).
By Kaplan-Meier product limit estimation, median survival time of 31 cases was 36 months
and the actuarial survival at 72 months was 83.1%. The median survival time of severe
aplastic anemia (32 months) was similar with that of moderately severe aplastic anemia (37
months). Factors associated with favourable survival were male sex and presence of
etiological factor (p<0.05).
Conclustions : In the present series, the survival rate of patients with aplastic anemia
were somewhat different from that of western countries. Since the prognosis of patients with
aplastifc anemia in Korea is more favourable. A randomized controlled study would be
needed to define the therapeutic role of bone marrow transplantation in patients with severe
aplastic anemia in Korea.
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KEYWORD
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