Steroids for Aplastic Anemia

Primary Treatment Framework

The American College of Cardiology is not applicable here, however, the standard first-line treatment for severe aplastic anemia depends on age and donor availability, not corticosteroids, with allogeneic hematopoietic stem cell transplantation (allo-HSCT) as first-line therapy if an HLA-matched sibling donor is available for patients under 50 years 1
For patients under 50 years, the conditioning regimen includes Cyclophosphamide-ATG (Cy-ATG), with Cyclophosphamide and ATG, as part of the first-line treatment 1
For patients without matched donors or over 50 years, immunosuppressive therapy with horse antithymocyte globulin (ATG) plus cyclosporine is the standard first-line treatment, as recommended by the National Comprehensive Cancer Network 1

For patients under 50 years who fail immunosuppression, proceeding to allo-HSCT with haploidentical donor (HID), matched unrelated donor (MUD), or cord blood transplant (CBT) is recommended, according to the National Comprehensive Cancer Network 1
For patients 50-60 years with ECOG ≤2 who failed immunosuppression, MSD or MUD transplantation is recommended, as per the guidelines 1

It is critical to distinguish aplastic anemia from myelodysplastic syndromes (MDS), as immunosuppression for hypoplastic MDS is a different entity, with evidence provided by the National Comprehensive Cancer Network and other organizations 2, 3, 4, 5, 6