Marrow Matters - Bone Marrow Transplant - Aplastic Anemia  


Aplastic Anemia Medications

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Bone Marrow Transplant & Medications

A New World Of Medications

If you entered into a Bone Marrow Transplant by way of Aplastic Anemia, you've very likely taken many new medications because of the very nature of the Aplastic Anemia disease. As Aplastic Anemia progresses, the bone marrow production of blood cells declines, which in turn causes a deficiency in red blood cells, white blood cells (neutropenia) and platelets (thrombocytopenia). When the white blood cell count drops too low, a person becomes 'neutropenic', which means they are less or unable to fight off infection on their own. When this occurs, medications are prescribed to, for example, assist the person in fighting off viral infections, bacterial infections, fungal infections and certain types of pneumonia.

Additionally, many new medications will be introduced to your body prior to a bone marrow transplant to prepare your body for the transplant. During that preparation, active cells and current defective bone marrow will need to be eliminated. At the heart of those preparatory regimes one is usually given chemotherapy.

After the transplant occurs, several other new medications will be introduced, and some of the old meds continued. New on the horizon will be an immunosuppressant to suppress the fighter white T-cells so that they don't attack the recipient of the donation, particularly the bone marrow.

This page is a work in progress; if you don't see the medication listed now, please check back... it is a growing list, too.

Medications 101




ATG is an acronym for Anti-thymocyte globulin, which is a medication sometimes prescribed to help treat Aplastic Anemia, while other times prescribed to help treat or prevent bone marrow transplant rejection. Two antithymocyte globulin agents are approved by the FDA for use: rabbit or horse. Both are used, both have sucesses, but by and large, horse ATG is more successful than rabbit.

Basically, ATG acts on T-lymphocytes to prevent or delay cellular rejection of transplanted organs. For that reason, it is also sometimes used to treat Aplastic Anemia, which can occur because T-cells kill off the very bone marrow that gave life to the T-cells.

Rabbit ATG has been used post transplant to reduce Graft-versus-Host Disease, which some successes. Higher doses increased infections, but may have reduced chronic symptoms. Talk with your doctor about the possibilities and if they are right for you.

ATG - for a good read on ATG, see Wikipedia

Avascular Necrosis

Simple put, Avascular Necrosis is the death of tissue or bone due to the lack of blood supply. It can be caused by disease, such as Aplastic Anemia, as well as drugs, such as Prednisone.

Brown Recluse Spider

Why in the world would we include anything about a spider here? Simple, you'll see. The bite from a brown recluse spider can cause cytotoxicity.

Cytoxan®, Neosar®, Generically known as Cyclophosphamide

Cytoxan is an alkylating antineoplastic agent; it is an immunosuppressive drug and chemotherapy used to treat cancer (Aplastic Anemia is NOT cancer, it is a bone marrow failure/immune disease), including leukemia and lymphomas, as well as nephrotic syndrome.

Cytoxan is often used during the preparation for a bone marrow transplant.

Cytoxan website


See Cytoxan


Cyclosporine is an immunosuppressant, and one of the frequently used immunosuppressive therapy drugs. It can prevent organ rejection after transplant in its oral form, and is used to treat rheumatoid arthritis and psoriasis.

See also Retasis, for eye drop information.

Cyclosporine was taken off of the market in every market worldwide, because it was thought that it was killing its patients when people were dying after cyclosporine had been administered. After much research, those fears were confirmed. It was found that the reason that Cyclosporine was killing people was because of its improper labeling. One wrong word on the labeling caused hundreds to die needlessly. Cyclosporine had been mixed according to the directions, with the wrong base solution. Once that was corrected, the company said it was safe.

Today, the United States may be the one and only medical industry that allows the use of Cyclosporine. It is widely used in the USA in treatment of diseases, preparation for transplants and as a maintenance drug or to treat GvHD.

Cyclosporine is known for many drug interactions, including increased neuro- and nephrotoxicity when coadministered with antibiotics, antifungals, or other immunosuppressants.


Cytotoxicity is the quality of being toxic to cells. An immune cell or venom from a brown recluse spider.


See Cytoxan

GvHD, aGvHD, cGvHD

GvHD is an acronym for Graft-versus-Host Disease. When it is preceded by an 'a', as in aGvHD, it refers to 'acute' GvHD; if it is preceded by a 'c', as in cGvHD, it refers to 'chronic' GvHD.

GvHD is, by definition, rejection. To be more accurate, if the transplanted cells are attacking the recipient, it would be referred to as Graft (the transplant) vs. Host (the recipient); whereas, if the recipient's (the patient's) cells are killing off the transplanted cells, it would technically be referred to as Host vs. Graft Disease. It seems as though that distinction is infrequently made nowadays.

Immune System

The immune system is the body's defense against infectious organisms and other invaders. Through a series of steps called the immune response, the immune system attacks organisms and substances that invade body systems and cause disease.


Immunosuppressants are medications, 'immunosuppressant drug', which reduce the person's immune system from capabilities of rejecting transplanted bone marrow (or a transplanted organ of any type).

There are two types of immunosuppressant medications and four classes, although the differentiation is usually only made at the clinical level: induction drugs and maintenance drugs.

Immunosuppressant Drugs - Types

Induction drugs are powerful antirejection medicines used at the time of the transplant.

Maintenance drugs are antirejection medicines used to maintain the transplant or keep it from rejection.

Immunosuppressant Classes

Calcineurin Inhibitors: Tacrolimus and Cyclosporine

Antiproliferative Agents: Prograf (Mycophenolate Mofetil), Mycophenolate Sodium and Azathioprine

mTor Inhibitor: Sirolimus

Steroids: Prednisone

immunosuppressive Therapy


Cellcept, Generic is Mycophenolate Mofetil





Prednisone is a steroid, which can treat so very many diseases and conditions, especially anything associated with inflammation.

Prednisone is a double-edged sword! It has its benefits, but it can leave its mark. For example, Prednisone is one of few drugs that can save a life suffering from a flare-up of GvHD. At the same time, it can cause Avascular Necrosis.

Prednisone is a Glucocorticoid, by drug class.


Retasis is cyclosporine in eye drop form.



Prograf (Protopic, Astagraf)

Voriconazole (VFend)