How Is Fanconi Anemia Treated?
Children with Fanconi anemia need life-long care and monitoring. The care team will develop a personalized treatment plan. This will help find and treat problems that happen due to the condition. This will include a yearly check-up, blood tests and bone marrow testing (usually starting at 2 years of age) to see how FA affects the child’s bone marrow. The doctor also may recommend testing the function of vital organs (such as the kidneys and heart) to check for any problems.
Commonly used therapies for bone marrow failure related to FA include:
- Transfusion support (example: blood and platelet transfusion)
- White blood cell count support with a growth factor called granulocyte-colony stimulating factor (G-CSF).
- Androgen, a type of male hormone, may increase the production of red blood cells and, often, platelets. This type of therapy works for some people but not for everyone. Androgens can steady blood counts or improve blood count long term. It is not a cure. It can cause unwanted side effects.
These options are used temporarily until the care team develops more definitive treatment plans.
The only potentially curative therapy currently available is bone marrow transplantation (BMT). BMT is a procedure that destroys unhealthy stem cells in a patient’s bone marrow. The unhealthy stem cells are replaced with healthy blood-forming stem cells from a donor. The care team may recommend BMT when a child’s bone marrow failure is becoming severe enough to require transfusions. They may also recommend BMT when the child develops myelodysplastic syndrome or leukemia. This procedure is also called an allogeneic hematopoietic stem cell transplant (HSCT).
BMT can cure blood problems related to Fanconi anemia. It also can get rid of the child’s risk of getting myelodysplastic syndrome and leukemia related to Fanconi anemia. If those conditions have already developed, BMT can treat them.
Bone marrow transplants for people with Fanconi anemia are complex and specialized. They should take place at a specialized center where experts have in-depth knowledge and expertise in this area of medicine.
What Are the Preventative Cancer Screening Guidelines for Fanconi Anemia?
Even after a successful BMT, patients with Fanconi anemia are at increased risk of developing solid tumors of the head and neck region and genital system. People with Fanconi anemia should have lifelong follow-up from their care team. The older a patient gets, the higher the risk of developing these cancers. It is important to take preventive measures and get regular screenings. These include:
- Starting the HPV vaccine series as early as 9 years old.
- Abstaining from alcohol, marijuana and tobacco.
- Wearing sunscreen and sun protection (long sleeves, hat) when outside during the day.
- Annual ENT visits with a NP scope (nasopharyngoscopy) beginning at 10 years of age or within the first year after HSCT. The doctor will look inside the mouth and insert a flexible scope through the nose and down the throat to check for sores or lesions. The frequency of NP scopes should be increased to every six months starting at 16 years of age.
- Proper oral hygiene and dental exams every six months.
- Annual EGD (Esophagogastroduodenoscopy) and colonoscopy starting at 18 years of age. The patient will be put to sleep and the doctor will examine the GI tract with a camera to look for any lesions or sores. A biopsy can also be performed to rule out cancer.
- Annual gynecology assessment beginning at 13 and vulvo-vaginal exams and pap smears starting at age 18 or when sexually active.
What Other Specialized Therapies and Surgeries Do People With Fanconi Anemia Need?
People with FA may need other types of care, such as:
- Heart surgery to correct heart defects
- Orthopedic surgery to correct skeletal problems
- Therapies for gastrointestinal, kidney or other problems related to Fanconi anemia
- Hormone therapy to treat poor growth, thyroid conditions and diabetes
Educational and emotional support from the treatment team help patients and families understand and cope with FA. Genetic counseling can also help.