Bone Marrow Failure Medication
- Author: Emmanuel C Besa, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP more...
Medication Summary
The approach to bone marrow failure depends on which mechanism is thought to predominate in the patient. If an immune mechanism is suspected, an immunosuppressive agent is used. Hematopoietic growth factors and androgens also have been tried in an effort to stimulate hematopoiesis.
As previously mentioned, androgens were used in the past for treatment of bone marrow failure, but most are masculinizing and poorly tolerated by females and children. Danazol is a nonmasculinizing androgen that may be useful. The response rate is limited to approximately 45%, and results may require 6-10 months of therapy.
Immunosuppressants
Class Summary
These are used to manipulate the bone marrow microenvironment and eliminate any immune-mediated bone marrow suppression. Intensive immunosuppression using a combination of ALG and cyclosporine has resulted in hematologic remission rates of 70-80% in patients with aplastic anemia.
Lymphocyte immune globulin (Atgam)
This agent, an antibody to T cells, is used as an immunosuppressive agent. Because it is extracted from horse serum, serum sickness may be induced when the drug is administered.
Cyclosporine A (Sandimmune, Neoral, Gengraf)
Cyclosporine A is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions, such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft versus host disease. For children and adults, the dosing should be based on ideal body weight.
Methylprednisolone (A-Methapred, Medrol, Solu-Medrol)
Methylprednisolone decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability.
Prednisone
Prednisone is used as an immunosuppressant in the treatment of autoimmune disorders. By reversing increased capillary permeability and suppressing polymorphonuclear leukocyte activity, it may decrease inflammation.
Androgens
Class Summary
These agents push the resting hematopoietic stem cells into cycle, making them more responsive to differentiation by hematopoietic growth factors. They also stimulate endogenous secretion of erythropoietin
Danocrine
Danocrine is an attenuated androgen that does not have adverse virilizing and masculinizing effects. It increases levels of the C4 component of the complement.
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