title: Efficacy and safety of immunosuppressive therapy in the treatment of seronegative hepatitis associated aplastic anemia.
abstract: OBJECTIVE
  To investigate the clinical characteristics of seronegative hepatitis-associated aplastic anemia (AA) (SNHAA) and hepatitis B virus (HBV) infection complicating AA (HBVAA), and thereby compare the efficacy of immunosuppressive therapy (IST).
  
  
  METHODS
  An analysis was conducted on the clinical data of ten patients with SNHAA out of 332 cases of AA from our center at AA diagnosis, and on the efficacy of IST. This was compared to 22 cases of HBVAA at AA onset as well as the associated IST outcomes.
  
  
  RESULTS
  Nine patients with SNHAA developed severe aplastic anemia, with a median age of 18 years. After IST, six (60%) of the SNHAA patients achieved complete remission and two achieved partial remission. The patients with HBVAA had a total response rate of 82.3%. The disease recurred in two HBVAA patients. No statistically significant differences were observed in response rate, mortality, and recurrence rate between both groups. As compared with HBVAA, patients with SNHAA had a shorter interval from the acute episode of hepatitis to AA onset (4 months versus 92 months, P=0.00), a quicker response to IST (2.5 months versus 4.5 months, P=0.018), a lower proportion of bone marrow hematopoietic tissues (20.6% versus 23.6%, P=0.03), and lower white blood cell and absolute neutrophil count (0.8 × 10(9)/L versus 1.23 × 10(9)/L and 0.26 × 10(9)/L versus 0.58 × 10(9)/L, P=0.026 and P=0.0009, respectively). No significant liver damage or hepatitis B fulminant infection was observed in either group during the follow-up.
  
  
  CONCLUSIONS
  The prevalence of SNHAA is 3.01%. SNHAA often presents as severe AA and responds to IST quickly. Neither hepatitis prior to AA nor AA complicating HBV infection have been shown to influence the early efficacy of IST and adverse events, and HBV may not be the causative agent of AA.
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Hai-Fei
authors.initials: HF
authors.lastname: Chen
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Bin-Xian
authors.initials: BX
authors.lastname: Xu
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Hong-Shi
authors.initials: HS
authors.lastname: Shen
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Zheng-Yang
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Ling-Juan
authors.initials: LJ
authors.lastname: Jin
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Jie-Qing
authors.initials: JQ
authors.lastname: Tang
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Zhu
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Long-Mei
authors.initials: LM
authors.lastname: Qin
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Qing-Ya
authors.initials: QY
authors.lastname: Cui
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Yong-Ya
authors.initials: YY
authors.lastname: Ren
authors.affiliation: Department of Hematology, 100th Hospital of People's Liberation Army, Suzhou, Jiangsu province, The People's Republic of China.
authors.forename: Tian-Qin
authors.initials: TQ
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000150:complications* / Q000188:drug therapy*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006515:Hepatitis B virus / Q000187:drug effects*; D006801:Humans; D007136:Immunoglobulins / Q000276:immunology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D016572:Cyclosporine
keywords: hepatitis B infection; hepatitis-associated aplastic anemia; liver injury