An Analysis of Efficacy of Androgenic Steroids in patients with Acquired Aplastic Anemia.

INTRODUCTION : Acquired aplastic anemia (AA) is a rare disease of unknown pathogenesis and disputed etiology. The diagnosis is based on the criteria proposed by international aplastic anemia and agranulocytosis study group. There are several etiological factors proposed for the same based on epidemiological studies which include drugs, toxic chemicals, radiation,etc. Most cases of aplastic anemia have an immune mediated pathogenesis. This is revealed by its response to immunosuppressive drugs. However non immune factors also play an important role. The role of HLA DR2 allele, cytokine gene polymorphisms and telomeres in aplastic anemia have been widely discussed. The treatment of choice of acquired aplastic anemia in young patients without comorbidities is haematopoietic stem cell transplant. Other important treatment modality is immunosuppressive drugs. Androgenic steroids gives good response in a subset of patients with acquired aplastic anemia. The exact mechanism of action is however not known. Recent studies have shown that it tends to protect from telomere shortening in haematopoietic tissues by increasing Telomerase activity, the specialized reverse transcriptase which helps in adding telomeres to chromosome ends. AIMS AND OBJECTIVES : 1. To analyze the clinical profile of patients (adults and children) with acquired aplastic anemia treated with androgenic steroids. 2. To assess the response to androgenic steroids in the above patients with acquired aplastic anemia. 3. To identify the demographic, clinical, and laboratory parameters that can predict response to androgenic steroids in the above mentioned patients. MATERIALS AND METHODS : This study protocol was approved by our Institutional Review Board (IRB). This is a retrospective analysis of patients diagnosed to have acquired aplastic anemia and treated with androgenic steroids from January 2008 to December 2012. Diagnostic criteria: Aplastic Anemia was diagnosed in patients presenting with cytopenia(s) (defined by International Agranulocytosis and Aplastic anemia study group in 1987 as presence of at least two of the following ie. Haemoglobin < 100g/L, neutrophil count < 1.5 x109/L and platelet count < 50 x 109/L) associated with a hypoplastic bone marrow (ie.bone marrow cellularity <25%, <50% if less