Published online 31 March 2009
Haematologica, Vol 94, Issue 5, 712-719 doi:10.3324/haematol.2008.002170
Copyright © 2009 by Ferrata Storti Foundation
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Aplastic Anemia

Hematopoietic growth factors in aplastic anemia patients treated with immunosuppressive therapy-systematic review and meta-analysis

Ronit Gurion1,3,*, Anat Gafter-Gvili1,3,*, Mical Paul2,3, Liat Vidal1,3, Isaac Ben-Bassat3, Moshe Yeshurun1,3, Ofer Shpilberg1,3, Pia Raanani1,3

1 Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center
2 Infectious Diseases Unit, Rabin Medical Center
3 Sackler School of Medicine, Tel Aviv University, Israel

Correspondence: Ronit Gurion, M.D, Institute of Hematology, Davidoff Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva 49100, Israel. E-mail:shay_gr{at}hotmail.com

Immunosuppressive therapy is the treatment for aplastic anemia patients ineligible for transplantation. The role of hematopoietic growth factors as adjunct to treatment in these patients is unclear. We conducted a systematic review and meta-analysis of randomized controlled trials comparing treatment with immunosuppressive therapy and hematopoietic growth factors to immunosuppressive therapy alone in patients with aplastic anemia. Two reviewers appraised the quality of trials and extracted data. For each trial, results were expressed as relative risks with 95% confidence intervals (CI) for dichotomous data. The addition of hematopoietic growth factors yielded no difference in overall mortality at 100 days, one year and five years [relative risks 1.33 (95% CI 0.56–3.18), relative risks 0.90 (95% CI 0.50–1.63) and relative risks 0.89 (95% CI 0.55–1.46), respectively]. There was no difference in overall hematologic response and in the occurrence of infections. HGF significantly decreased the risk for relapse, relative risks 0.45 (95% CI 0.30–0.68, 3 trials). Hematopoietic growth factors were not associated with higher occurrence of myelodysplastic syndrome and acute myeloid leukemia or paroxysmal nocturnal hemoglobinuria. The addition of hematopoietic growth factors does not affect mortality, response rate or infections occurrence. Therefore, it should not be recommended routinely as an adjunct to the immunosuppressive therapy for patients with aplastic anemia.

Key words: hematopoietic growth factors, aplastic anemia, immunosuppressive therapy.