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Abstract The choice of primary treatment of aplastic anemia should be based on: 1- The availability of an HLA identical sibling. 2- The age of the patient, and 3- The severity of the disease. A) Early bone marrow transplantation remains the treatment of choice . for younger patients with severe acquired aplastic anemia who have an HLA identical sibling. It is essential that BMT is performed before sensitisation through blood transfusion or major systemic infection associated with neutropenia occurs. The upper age limit of recipients eligible for identical BMT is not generally agreed. All patients under 40-45 years of age should be considered. Above this age the relative merits of transplantation and immunosuppressive . therapy should be weighed up for individual patients (Hows, 1999). B) Patients, without a donor, patients above the age of 50 and patients with non-severe AA should be given immunosuppressive therapy (IS) as first line of treatment (Schrezenmeier, 1999): * Antithymocyte globulin or antilymphocyte globulin (ATG): is still the gold standard of IS in AA. Response rates in clinical trials with ATG . either alone or in combination with other drugs varied between 40 and 75%. |