Aplastic Anemia — Equine ATG Therapy Protocol — Clinical Pathway

Aplastic Anemia Clinical Pathway — All Settings

Equine ATG Therapy Protocol

This regimen is recommended for the pharmacologic treatment of newly diagnosed aplastic anemia.

Treatment Recommendations

*If weight on orders differ by more than 5% from admission weight, contact attending MD for additional instructions.

Pharmacologic Element Dosage Special Instructions
Anti-thymocyte Globulin, Equine (ATG) 40 mg/kg on Day 1, 2, 3, 4
  • Administer first dose of ATG over @ least 8 hours.
    • Concentration of 4mg/ml.
    • Rate: 0.7 mls/kg/hour for first hour,
    • then 1.4 mls/kg/hour for the remainder of the infusion.
  • If the patient has tolerated the first dose, infusion duration of ATG for days 2-4 should be 6 hours. Otherwise, the infusion duration should be 8 hours.
Cyclosporine
  • Children & adults receiving Voriconazole
    • Dose: 2.5 mg/kg every 12 hours
    • Maximum dose: 200 mg
  • Children & adults NOT receiving Voriconazole
    • ≤ 12 years of age
      • Dose: 7.5 mg/kg every 12 hours
      • Maximum dose: 400 mg
    • > 12 years of age
      • Dose: 5 mg/kg every 12 hours
      • Maximum dose: 400 mg
 Target trough blood level 150-300 ng/ml

Ensure that patient receives “Neoral” not generic substitute
Methylprednisolone or Prednisone
  • Dose: 0.5 mg/kg every 12 hours, IV for first 4 days
  • Maximum dose: 50 mg/dose
 Switch to PO on discharge @ same dose. Begin 2 week taper on day 10 (since initiation)
H2 Blocker: Famotidine Refer to Formulary – Famotidine   Continue while on steroids.
Pentamidine Refer to Formulary – Pentamidine   For duration: Refer to Antimicrobial Stewardship Guidelines
Voriconazole Refer to Formulary – Voriconazole   Should be initiated at the time of immunosuppressive therapy

For duration: Refer to Antimicrobial Stewardship Guidelines
G-CSF Starting dose: 5 mcg/kg/dose SQ, titrate as clinically needed

Daily maximum dose: 480 mcg/day
  • Indication:
    • ANC < 200
    • Prolonged neutropenia with ANC < 500

*For special instructions or further information about ordering at CHOP, please see internal link.