[Reference guide for the treatment of aplastic anemia: key points of the 2022 revision]

The "Reference Guide for the Treatment of Aplastic Anemia" has been revised for the first time in 3 years, and clinical questions have been formulated for the first time. As research demonstrated a benefit to combining antithymocyte globulin (ATG) and cyclosporine with eltrombopag (EPAG), the revised guide recommends that EPAG be started as soon as possible after ATG administration. In addition, it states that starting with immunosuppressive therapy and performing allogeneic bone marrow transplantation in the event of inadequate response or relapse is an option even for young adult patients with severe aplastic anemia who have HLA-matched allogeneic bone marrow donor candidates. The guide also discusses aggressive treatment of non-severe cases, ATG dosage and the maximum age for ATG administration, infection prevention, and G-CSF administration. It is necessary to continue collecting evidence and promoting clinical trials to build evidence in Japan.