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The study including 30 children had SAA. Ten were a retrospective cohort treated with CsA monotherapy. The other 20 were prospective cohort received E-PAG + CsA. All patients were evaluated for partial (PR) and complete (CR) hematological response at 3, 6, and 12 months. overall response (OR), overall survival rates (OS), and treatment safety. OR for the E-PAG patients was 40% after 3 months of therapy. At 6 months, this had increased to 75% with significantly higher CR rate (40%) than in the CsA group (<jats:italic>p<\/jats:italic> = 0.0001). After a year of treatment, the CR for the E-PAG + CsA regimen had increased to 50% and the OR to 85%, compared to 20% in the CsA group (<jats:italic>p<\/jats:italic> = 0.0001). The OS at 12 months was 100% in the E-PAG+ CsA group compared to 80% in the CsA cohort. At 24 months, the OS in the E-PAG + CsA group was 90%. In conclusion, E-PAG+ CsA was found to be a safe and effective alternative treatment for children with SAA particularly in countries with limited resources.<\/jats:p>","DOI":"10.1007\/s00277-023-05440-x","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T19:01:25Z","timestamp":1694631685000},"page":"2997-3006","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Alternative treatment modality for severe aplastic anemia in a resource-limited setting: a single-institution prospective cohort study from Upper Egypt"],"prefix":"10.1007","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9054-0662","authenticated-orcid":false,"given":"Mervat A M","family":"Youssef","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed H","family":"Ghazaly","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai A","family":"Abdelfattah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"issue":"2","key":"5440_CR1","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.hoc.2009.01.011","volume":"23","author":"EC Guinan","year":"2009","unstructured":"Guinan EC (2009) Acquired aplastic anemia in childhood. 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