Aplastic Anæmia in Childhood: A Reappraisal Ii. Idiopathic and Acquired Aplastic Anæmia

The progress of 92 children with idiopathic and acquired aplastic anaemia was analysed, with a minimum follow-up period of five years in the surviving patients. Sixty-one were treated with androgens and 31 received corticosteroids or supportive therapy. The overall survival rate was 25%. Despite a higher incidence of initial remissions in the androgen- treated group, nearly half relapsed, and the crude survival rate after five years did not differ significantly in the two therapeutic categories — 26% for the androgen group and 23% for the non-androgen group. Two of the 92 patients relapsed with acute leukaemia. It is suggested that achievement of complete remission may occur up to four years from diagnosis, and that relapse, if it occurs, will develop within four and a half years from diagnosis. In the drug-induced aetiological group, the crude survival rate appeared best for those whose marrow aplasia was attributed to prolonged courses of drugs; the survival rate also appeared better for those who received repeated rather than single short courses of chloramphenicol. In the androgen-treated group, more favourable prognostic factors for initial remission but not necessarily ultimate survival were initial reticulocyte counts exceeding 0.5%, fetal haemoglobin levels above 500 mg/100 ml, and lymphocyte proportions in the bone marrow below 70%.