From the Research
Cyclosporine dosing in aplastic anemia should start with an initial dose of 3 mg/kg in adults and 5 mg/kg in children every other day, with adjustments based on trough levels and clinical response, as evidenced by the most recent study 1. The goal of cyclosporine therapy in aplastic anemia is to maintain whole blood trough levels between 200-400 ng/mL, with the aim of stimulating hematopoiesis while minimizing toxicity.
- Key considerations in initiating therapy include:
- Baseline measurements of complete blood count, renal and liver function tests, and electrolytes
- Monitoring cyclosporine trough levels twice weekly initially, then weekly once stable
- Adjusting the dose in increments of 25-50 mg based on trough levels and clinical response
- Regular monitoring should include:
- Weekly blood counts
- Twice-monthly renal and liver function tests
- Blood pressure measurements at each visit
- Dose reductions are necessary if:
- Creatinine increases >30% from baseline
- Blood pressure exceeds 160/95 mmHg despite antihypertensive therapy
- Significant adverse effects occur
- Once hematologic parameters stabilize, consider a slow taper (by 25 mg every 2-4 weeks) to the lowest effective dose that maintains response, typically continuing therapy for at least 12 months before considering discontinuation, as supported by the study 1. This approach is based on the most recent and highest quality study available, which demonstrated the efficacy and safety of this regimen in patients with severe aplastic anemia 1.