[Outcomes of very severe aplastic anemia patients with different absolute neutrophil counts after frontline immnunosuppressive therapy].
OBJECTIVE
To analyze early hematopoietic response and long-term survival of very severe aplastic anemia (VSAA) patients with different absolute neutrophil counts (ANC) after frontline immnunosuppressive therapy (IST).


METHODS
Clinical data and outcome of 145 VSAA patients treated with rabbit antithymocyte globulin combined with cyclosporine were retrospectively analyzed. Hematopoietic responses to IST and long-term survival were statistically analyzed for VSAA patients in different ANC subgroups.


RESULTS
Pre-IST ANC=0.05×10(9)/L acted as the best cutoff level to predict IST response at 3, 6 months. For 145 VSAA patients, early death rate was 13.4% (11/82) vs 1.6% (1/63), respectively, in the ANC≤0.05×10(9)/L group and ANC>0.05×10(9)/L group (P<0.05). Hematopoietic response rates to IST was 22.0% vs 54.0% (P=0.000) at 3 months, 34.1% vs 63.5% (P=0.000) at 6 months; the overall five-year survival rate was only (62.5±5.4) % vs (91.4±3.7) % (P=0.000) and five-year event-free survival rate was (42.3±5.5) % vs (63.1±6.5) % (P=0.003), respectively, in the ANC≤0.05×10(9)/L group and ANC>0.05×10(9)/L group.


CONCLUSIONS
VSAA patients with extremely low ANC (≤0.05×10(9)/L) had high early death rate and with very low response rate to frontline IST and poor survival, so it is urgent to seek for the alternative frontline therapy that will bring faster and better outcome for these patients.
Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
Yang
Y
Li
Zhijie
Z
Wu
Xin
X
Zhao
Li
L
Zhang
Liping
L
Jing
Kang
K
Zhou
Guangxin
G
Peng
Lei
L
Ye
Yuan
Y
Li
Jianping
J
Li
Huihui
H
Fan
Lin
L
Song
Wenrui
W
Yang
Bo
B
Jiang
Fengkui
F
Zhang
D000741:Anemia, Aplastic / Q000097:blood / Q000188:drug therapy*; D000818:Animals; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007958:Leukocyte Count; D009504:Neutrophils / Q000166:cytology*; D011817:Rabbits; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine