, Volume 97, Issue 5, pp 551-552
Date: 21 Apr 2013

Guest Editorial: Advances in the management of acquired aplastic anemia

This is an excerpt from the content

Acquired aplastic anemia (AA) is a poorly characterized disease. The pathophysiology of AA can be simply explained by a decrease in the number of hematopoietic stem cells (HSCs); however, how the HSCs are lost remains unknown, despite vigorous efforts to clarify the mechanism. It has been considered that an autoimmune mechanism, such as a cytotoxic T cell attack against HSCs, causes AA. The most compelling evidence for such an immune mechanism, however, is derived from clinical observations that approximately two-thirds of AA patients improve with immunosuppressive therapy (IST). The management of AA improved greatly over the past 20 years, mainly owing to the introduction of IST, including anti-thymocyte globulin (ATG) and cyclosporine, and advances in allogeneic bone marrow transplantation (BMT) from unrelated donors.

However, a number of issues still need to be resolved regarding the clinical management of AA. First, the 60–70 % response rate of patients with AA to IST is far from sa