Immunosuppressive therapy in adults with aplastic anaemia: single-institution experience from India.

Abstract

OBJECTIVE:

To determine overall survival and factors predicting survival after immunosuppressive therapy in patients with acquired aplastic anaemia.

DESIGN:

Retrospective.

SETTING:

Tertiary care hospital.

PATIENTS:

120 adults diagnosed as having acquired aplastic anaemia between 1 January 1996 and 31 December 2009.

INTERVENTIONS:

Anti-thymocyte globulin (ATG) followed by ciclosporin was administered to all patients for 15-18 months as the initial treatment. Haematological response was assessed 6 months after ATG administration and 6-monthly thereafter. Platelets were transfused if levels were <10 × 10(3)/l and for symptomatic bleeding. Transfusions of red blood cells were given for haemoglobin levels <70 g/l or symptomatic anaemia. Febrile neutropenia was managed with antibiotics, with the addition of antifungal agents after 3-4 days of unresponsive fever. Granulocyte colony-stimulating factor was administered at a dose of 5 µg/kg/day (maximum 300 µg/day) subcutaneously for infective episodes.

MAIN OUTCOME MEASURES:

PRIMARY OUTCOME:

overall survival. Secondary outcome: response to immunosuppressive therapy, failure-free survival, relapse and clonal evolutions. The response and relapse criteria were defined in accordance with the British Council for Standards in Haematology guidelines.

RESULTS:

Overall response at 6 months after initiation of treatment was 85.8% (103/120). Overall survival at 76 months was 83.4%. Overall survival correlated with presence of response (complete response or partial response) at 6 months after ATG administration (HR=0.021, 95% CI 0.006 to 0.079, p<0.001). The occurrence of infectious complications adversely affected the overall survival (HR=5.71, 95% CI 1.22 to 26.77, p=0.027). Six patients relapsed. There were no deaths or adverse events 12 months after treatment among responders.

CONCLUSIONS:

In our study, overall survival was 83.4% at a median follow-up of 76 months. The two variables that significantly affected overall survival were response to therapy at 6 months and occurrence of infectious complications.

• Authors: Velu Nair, Ajay Sharma, Satyaranjan Das, Vishal Sondhi, Sanjeevan Sharma
• Journal: Postgraduate medical journal (Postgrad Med J) Vol. 89 Issue 1055 Pg. 508-15 (Sep 2013) ISSN: 1469-0756 [Electronic] England
• PMID: 23686628 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antilymphocyte Serum
• Immunosuppressive Agents
• Granulocyte Colony-Stimulating Factor
• Cyclosporine
• nartograstim

Topics

• Adult
• Aged
• Anemia, Aplastic (drug therapy)
• Antilymphocyte Serum (therapeutic use)
• Cyclosporine (therapeutic use)
• Febrile Neutropenia (drug therapy)
• Female
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Immunotherapy
• India (epidemiology)
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Survival Rate
• Tertiary Care Centers
• Treatment Outcome
• Young Adult