Special issues related to the diagnosis and management of acquired aplastic anemia in countries with restricted resources, a report on behalf of the Eastern Mediterranean blood and marrow transplantation (EMBMT) group and severe aplastic anemia working party of the European Society for blood and marrow transplantation (SAAWP of EBMT)

Abstract

Aplastic anemia is a relatively rare but potentially fatal disorder, with a reported higher incidence in developing countries in comparison to the West. There are significant variations in epidemiological as well as etiological factors of bone marrow failure syndromes in the developing countries in comparison to the developed world. Furthermore, the management of bone marrow failure syndromes in resource constraint settings has significant challenges including delayed diagnosis and referral, limited accessibility to healthcare facilities, treatment modalities as well as limitations related to patients who require allogeneic stem cell transplantation. Here we will provide a review of the available evidence related to specific issues of aplastic anemia in the developing countries and we summarize suggested recommendations from the Eastern Mediterranean blood and bone marrow transplantation (EMBMT) group and the severe aplastic anemia working party of the European Society of blood and marrow transplantation (SAAWP of EBMT) related to the diagnosis and therapeutic options in countries with restricted resources.

Response to Immunosuppressive Therapy in Patients of Acquired Aplastic Anaemia: A Single Center Experience From a Developing Country

“…The higher observed incidence of aplastic anaemia in eastern population is likely linked to increased marital consanguinity, higher incidence of viral hepatitis, prevalent use of herbal and alternative medicine, role of HLA susceptibility and protective loci, aldehyde dehydrogenase enzyme and lack of genetic testing facility to adequately distinguish bone marrow failure syndromes from immune aplastic anaemia. 13 In our study, disease severity alone was an independent predictor of inferior survival. CSA along with MMF and androgens were also associated with inferior survival.…”

“…The response rate in our study correlated with disease severity (p<0.001) as demonstrated by other international studies. 13,14 The response rate to combined IST is 50-78% 1 in Western literature and 40-70% in Indian subcontinent 15,16 . The inferior response rate in our study is likely due to use of single agent CSA in majority of patients (69.2%) and NSAA population being only 22.8%.CSA alone gave an ORR of 52.6% in the NSAA population.…”

Estimative of costs of two therapeutic schemes for aplastic anemia among young individuals

“…Based on the literature, the typical patient is male, 14 years old, weighing 49 kg, without previous immunosuppressive therapy use, with a history of more than 20 blood transfusions, without family history of hematological disease. (Arcuri et al, 2020;Iftikhar et al, 2021;Organization, 2007) One of the known models in cost-effectiveness studies is the Markov model, which considers both the use of resources and the outcomes and has been disseminated as a model of economic decision at the health sector. This study brings the initial step of using the complex Markov model.…”

Use of Cyclosporine A and danazol in treatment of aplastic anemia: A real-world data from a teaching hospital in South India

“…Standard of care, that is, stem cell transplantation or IST is not possible in developing countries due to lack of resources and due to logistic reasons. 8 Hence, in many of the centers, CsA is given along with anabolic steroids such as danazol as an alternative option. 9 Eltrombopag is added to this combination if the patient affords this treatment.…”