Is the early cyclosporine A level predictive of the outcome of immunosuppressive therapy in severe aplastic anemia?
Immunosuppressive therapy (IST) has provided an alternative treatment option for cure of aplastic anemia patients who cannot receive bone marrow transplantation. Although there have been many recent studies on the efficacy of antithymoglobulin (ATG) combined with cyclosporine A (CsA), there is no data on the correlation between the variability of CsA levels and the response to IST. Therefore, we retrospectively assessed the factors associated with IST efficacy in patients with acquired severe aplastic anemia (SAA). Sixty-six patients were treated with ATG combined with CsA for 6 months. In the response group, the CsA levels were increased rapidly to more than 200 ng/mL within the first 2 wk after starting the IST. However, the non-response group had a pattern of slower increase of the CsA levels. The CsA levels, during the first and second week of treatment with IST, were significantly different in the responders and non-responders. The factors predictive of response to IST and survival were analyzed. The univariate analysis showed that a younger age at the initiation of IST, a high absolute neutrophil count prior to starting IST, a short interval between the diagnosis and initiation of IST, and high CsA levels during the first and second week of IST treatment were positively associated with the response rate and overall survival. The multivariate analysis showed that these four factors were independent factors associated with a longer patient survival. A high response rate was associated with a short interval between diagnosis and initiation of IST as well as high CsA levels during the first and second week of IST. Therefore, early intensification of CsA levels might improve patient outcome.
Song
Moo-Kon
MK
Department of Internal Medicine, School of Medicine, Pusan National University Hospital Medical Research Institute, Busan, Korea.
Chung
Joo-Seop
JS
Joo
Young-Don
YD
Kim
Yang-Soo
YS
Kim
Sung-Hyun
SH
Seol
Young-Mi
YM
Shin
Ho-Jin
HJ
Choi
Young-Jin
YJ
Cho
Goon-Jae
GJ
D000328:Adult; D000368:Aged; D000741:Anemia, Aplastic / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D016572:Cyclosporine / Q000008:administration & dosage* / Q000097:blood*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000097:blood*; D053208:Kaplan-Meier Estimate; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D013601:T-Lymphocytes / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine