Bare with me ~ Insight on AA

[mquinn]

I am new to this disease. So new that I just learned about it's existence today!

One of the Mom's in my 7 year old son's class was diagnosed yesterday with Aplastic Anemia. Our sons have become pretty good friends and our families have become close in the past year. Because my 9 year old daughter has Leukemia (in remission since 2009), when my friend started feeling tired and sick and was telling me of her symptoms, I knew right away that she was having an issue with her blood. She's been in and out of the hospital for 3 weeks now. They FINALLY did the bone marrow aspiration a few days ago and diagnosed her with aplastic anemia yesterday. They said that her body is producing only 10% of her bone marrow right now. What is your opinion about the protocal with these circumstances? I've read things about chemotherapy, radiation and bone marrow transplants...they told her she'd need a bone marrow transplant, but they are going to try a few drugs. Are there drugs that can help your body PRODUCEe bone marrow? I was just hoping as a newbie to this that maybe I could get some information here?

Many thanks!

[Lisa V]

Treatment will depend on whether she has been diagnosed as moderate, severe or very severe AA. This is based on both marrow cellularity and blood counts, not just one or the other. If it is moderate (MAA), the usual approach is just watch and wait.

If it is SAA or VSAA, the protocol generally goes as follows: if she is under 40 years of age and has an HLA matched sibling, then bone marrow transplant would be the recommended first line of treatment. If she does not have a sibling match, or if she is over 40, then the usual approach is to try immunosuppresant therapy (IST). If that doesn't work, then a transplant with an unrelated donor may be the next option to explore.

There are some other options as well. High dose cytoxan and various monoclonal antibodies are currently being explored, but still considered comparatively experimental. They may involve either going to a specific center or being enrolled in a clinical trial. Currently the ATG/cyclosporine (IST) protocol is considered to be the standard, and the most widely practiced.

ATG/cyclo doesn't actually grow marrow so much as it knocks out the autoimmune attack that is thought to be short-circuiting proper marrow function. By killing off the attacking T-lymphocytes, the marrow is given a chance to recover on its own. This can be a very slow and sometimes incomplete process, and of course immune suppression is not without risk.

ATG is not chemotherapy, but chemo is a part of the transplant process (or in the case of high-dose cytoxan, used on its own without transplant).

I suggest you send for the AA&MDSIF's informational booklet on AA, or read the overview on their website: http://www.aamds.org/about/aplastic-anemia/diagnosis
You can also find a lot of more specific information reading through some of the threads on this forum.

Hope this helps, and good luck to your friend!