Search

Objective Immunosuppressant therapy (IST) with antithymocyte globulin (ATG) and cyclosporine is an established treatment option for patients with aplastic anemia (AA), who are not eligible for allogeneic stem cell transplantation. However, data on the dose of ATG and its efficacy from the developing countries is minimal. Methods We performed a retrospective analysis of all AA patients (age >12 years), treated with equine ATG and cyclosporine from a single center in India. Patients who received or were eligible for stem cell transplantation were excluded. The overall response rate (ORR) to IST was calculated at 3 and 6 months. We also determined the influence of using a lower dose of Atgam ATG (25 mg/kg/day × 4 days) and compared its efficacy against the standard dose of locally manufactured Thymogam ATG (40 mg/kg/day × 4 days). Factors influencing the ORR were analyzed using Fisher's exact test with a significant P < 0.05. Results Thirty-nine patients with AA treated with ATG and cyclosporine were studied. Median age was 31 years with a male:female ratio of 0.85:1. The ORR was 58% at 3 months, 77% at 6 months and was similar with lower dose Atgam and standard dose Thymogam. On multivariate analysis of ORR at 6 months, the interval between the onset of symptoms to the initiation of therapy was close to attaining statistical significance (odds ratio 23.53, P value 0.053) while the other variables did not attain significance. Conclusions IST with equine ATG in a lower dose (25 mg/kg/day × 4 days) and cyclosporine is a feasible and effective treatment option for AA in resource-constrained settings. [ABSTRACT FROM AUTHOR]

We report a primary bone marrow diffuse large B-cell lymphoma in a 52-year-old post-menopausal woman that evaded definitive diagnosis initially due to deceptive clinical features, non-contributory radiological findings, and an extensive reactive lymphoid infiltrate masking the relatively few neoplastic B-cells on bone marrow biopsy. The correct diagnosis was apparent only after a repeat bone marrow procedure and review of the previous histology and immunohistochemistry. The case illustrates the pitfall of assuming mixed B- and T-cell infiltrates in the bone marrow to be invariably benign. A high index of suspicion regardless of the clinical and/or radiological absence of lymphadenopathy or organomegaly and critical examination of each individual cell population in immunohistochemically stained material are essential for correct identification of this rare entity. [ABSTRACT FROM AUTHOR]