Traitement de l'aplasie médullaire idiopathique en 2015

Idiopathic aplastic anemia is a rare hemopoietic stem cell disorder that results in pancytopenia and hypocellular bone marrow. Allogeneic bone marrow transplantation from an HLA-identical sibling donor is the choice treatment for young patients (40 years of age or less) and leads to long-term survival in the majority of patients (> 90 %). For patients without a sibling donor, transplantation from a well-matched unrelated donor can be considered after failure of a previous course of immunosuppressive therapy. For patients who do not have a matched unrelated donor or who are not eligible for transplantation, a new course of immunosuppression can be discussed, as well as other treatment possibilities including androgens or eltrombopag. Alternative allogeneic stem cell transplantation (cord blood, haplo-identical transplantation or from mismatched donor), as well as upfront matched unrelated donor transplantation are still experimental and should not be completed outside clinical trials. This review illustrates an educational session on aplastic anemia, which took place at the last French society meeting in Paris and summarizes the treatment algorithm in patients with idiopathic aplastic anemia in 2015.