How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?

Such as patients who are frail, elderly, renally impaired?

Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity profile?

Answer from: at Academic Institution

There are relatively few alternatives. One is just supportive care with transfusion, antibiotics, etc. Many patients will adapt to low Hb and do ok with low platelets and do not require therapy. A calcineurin inhibitor alone or with eltrombopag can also be used - the response rate is not as go...

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at Kaiser Permanente, Los Angeles Med Center
Thank you, Dr. @Joseph H. Antin! Very helpful.

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How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?

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