title: [Clinical analysis on malignant clonal hematopoiesis in severe aplastic anemia patients with immunosuppressive therapy].
abstract: OBJECTIVE
  To investigate the clinical characteristics and risk factors of monosomy 7 malignant clonal evolution in patients with severe aplastic anemia (SAA) treated with combined immunosuppressive therapy (IST).
  
  
  METHODS
  The clinical data of SAA patients treated with IST who had monosomy 7 malignant clonal evolution from October 2004 to January 2012 were analyzed respectively.
  
  
  RESULTS
  Six patients (4.2%) had monosomy 7 clonal evolutions. The median time to monosomy 7 was 36 (12-75) months after IST. All 6 patients were diagnosed myelodysplastic syndromes (MDS). Among them, 3 patients transformed to acute myeloid leukemia following MDS. The time was 24, 45 and 51 months after IST. The median following time was 42 (17-84) months. Four patients died during the following time. The median time from MDS to death was 9 (5-17) months. Among them, three patients died with infection, one died with cerebral hemorrhage. Six patients had the clinical characteristics that they had no response to IST after 6 months, high monocyte percentage in one month after IST combined with recombinant human granulocyte colony stimulating factor (rHu-GCSF) and agranulocytosis in 3 months after IST.
  
  
  CONCLUSIONS
  Poor myeloid response to IST suggests malignant clonal hematopoiesis and poor prognosis in SAA patients.
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Ningbo
authors.initials: N
authors.lastname: Cui
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Fu
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Qu
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Erbao
authors.initials: E
authors.lastname: Ruan
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Guojin
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Guan
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Limin
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Lijuan
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Huijuan
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Yihao
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China.
authors.forename: Huaquan
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Hematology, General Hospital, Tianjin Medical University, Tianjin 300052, China; Email: shaozonghong@sina.com.
authors.forename: Zonghong
authors.initials: Z
authors.lastname: Shao
mesh_terms: D000741:Anemia, Aplastic; D002872:Chromosome Deletion; D002897:Chromosomes, Human, Pair 7; D016179:Granulocyte Colony-Stimulating Factor; D006410:Hematopoiesis; D006801:Humans; D007166:Immunosuppressive Agents; D015470:Leukemia, Myeloid, Acute; D009000:Monocytes; D011994:Recombinant Proteins; D012307:Risk Factors
chemical_list: D007166:Immunosuppressive Agents; D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor