Reassessing the six months prognosis of patients with severe or very severe aplastic anemia without hematological responses at three months after immunosuppressive therapy.
10.3760/cma.j.issn.0253-2727.2022.05.008
- Author:
Xiang Rong HU
1
;
Xin ZHAO
1
;
Li ZHANG
1
;
Li Ping JING
1
;
Wen Rui YANG
1
;
Yuan LI
1
;
Lei YE
1
;
Kang ZHOU
1
;
Jian Ping LI
1
;
Guang Xin PENG
1
;
Hui Hui FAN
1
;
Yang LI
1
;
Yang YANG
1
;
You Zhen XIONG
1
;
Feng Kui ZHANG
1
Author Information
1. State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
- Publication Type:Journal Article
- Keywords:
Anemia, aplastic;
Immunosuppressive therapy;
Prognostic factors
- MeSH:
Anemia, Aplastic/drug therapy*;
Antilymphocyte Serum/therapeutic use*;
Cyclosporine/therapeutic use*;
Humans;
Immunosuppression Therapy;
Immunosuppressive Agents/therapeutic use*;
Prognosis;
Receptors, Transferrin/therapeutic use*;
Retrospective Studies;
Treatment Outcome
- From:
Chinese Journal of Hematology
2022;43(5):393-399
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To reassess the predictors for response at 6 months in patients with severe or very severe aplastic anemia (SAA/VSAA) who failed to respond to immunosuppressive therapy (IST) at 3 months. Methods: We retrospectively analyzed the clinical data of 173 patients with SAA/VSAA from 2017 to 2018 who received IST and were classified as nonresponders at 3 months. Univariate and multivariate logistic regression analysis were used to evaluate factors that could predict the response at 6 months. Results: Univariate analysis showed that the 3-month hemoglobin (HGB) level (P=0.017) , platelet (PLT) level (P=0.005) , absolute reticulocyte count (ARC) (P<0.001) , trough cyclosporine concentration (CsA-C0) (P=0.042) , soluble transferrin receptor (sTfR) level (P=0.003) , improved value of reticulocyte count (ARC(△)) (P<0.001) , and improved value of soluble transferrin receptor (sTfR(△)) level (P<0.001) were related to the 6-month response. The results of the multivariate analysis showed that the PLT level (P=0.020) and ARC(△) (P<0.001) were independent prognostic factors for response at 6 months. If the ARC(△) was less than 6.9×10(9)/L, the 6-month hematological response rate was low, regardless of the patient's PLT count. Survival analysis showed that both the 3-year overall survival (OS) [ (80.1±3.9) % vs (97.6±2.6) %, P=0.002] and 3-year event-free survival (EFS) [ (31.4±4.5) % vs (86.5±5.3) %, P<0.001] of the nonresponders at 6 months were significantly lower than those of the response group. Conclusion: Residual hematopoietic indicators at 3 months after IST are prognostic parameters. The improved value of the reticulocyte count could reflect whether the bone marrow hematopoiesis is recovering and the degree of recovery. A second treatment could be performed sooner for patients with a very low ARC(△).
