[Retreatment with immunosuppression for 23 patients with refractory or relapsed severe aplastic anemia].

Objective: This study aims to evaluate the efficacy and safety of secondary immunosuppressive therapy (IST) in refractory or relapsed severe aplastic anemia. Methods: The hematologic response and safety of 23 patients with refractory or relapsed SAA treated with secondary IST (including ATG/ALG + cyclosporine or HD-CTX) in our hospital were retrospectively analyzed. Results: A total of 23 patients were involved, including 11 males and 12 females, with a median age of 21 (11-62) years. In the refractory group, the interval of IST was 7 (6-12) months. In the relapsed group, on the other hand, the interval between two courses of IST was 39 (14-51) months. At 6 months after IST, the overall response rate was 69.5% (16/23) ; 60% (6/10) of the refractory group vs 77% (10/13) of the relapsed group; 64% (7/11) of the ATG/ALG group vs 75% (9/12) of the HD-CTX group. Among the patients who got the hematologic response, two patients relapsed again, all of them from the relapse group. After the third IST, they got the response again. Conclusion: The second IST is safe and effective for refractory and relapsed SAA patients; the early serologic reaction should be paid attention to when using the same ATG/ALG, and the risk can be reduced by changing the type of ATG/ALG or other IST programs. The third IST can still obtain the treatment response for the second relapse patients.目的： 分析难治/复发重型再生障碍性贫血（SAA）患者二次免疫抑制治疗（IST）的疗效和安全性。 方法： 回顾性分析23例IST难治或复发SAA患者应用二次IST[包括抗胸腺/淋巴细胞球蛋白（ATG/ALG）+环孢素A或大剂量环磷酰胺（HD-CTX）方案]的临床资料及疗效。 结果： 共23例患者纳入研究，男11例，女12例，进行二次IST时的年龄为21（11~62）岁。难治SAA共10例，两次IST间隔时间为7（6~12）月。复发SAA患者13例，初次IST至复发时间为36（9~50）个月，复发至二次IST时间为1（0.5~24）个月，两次IST间隔时间为39（14~51）个月。6个月总体血液学反应率为69.5%（16/23）；二次IST开始1周内早期死亡2例，均为两次IST应用相同剂型ATG/ALG患者。分组疗效：难治SAA 60%（6/10），复发SAA 77%（10/13）；二次IST药物选择ATG/ALG组64%（7/11），HD-CTX组75%（9/12）。获得血液学反应的患者中2例患者再次复发，均为复发组患者，第三次应用IST后再次获得治疗反应。 结论： 二次IST是难治与复发SAA患者安全有效的治疗手段；应用相同剂型ATG/ALG进行二次IST时应注意早期血清病反应，更换ATG/ALG剂型或换用其他IST方案可减少相关风险；二次复发患者应用第三次IST仍有机会获得治疗反应。.