Intensive Immunosuppression Combined With Eltrombopag In The Treatment Of Elderly Patients With Severe Aplastic Anemia

Objective: To investigate the efficacy of eltrombopag combined with intensive immunosuppressive therapy in the treatment of patients with elderly severe aplastic anemia(SAA).Methods: Collected clinical data from 17 patients with confirmed severe regenerative disorder serotonin in the department of hematology of eltrombopag in the hematology department of Jiangsu Provincial People’s Hospital from November 2017 to September 2019,assessed efficacy and tolerance,and analyzed the therapeutic response and predicted survival factors.A total of 17 patients with elderly SAA were treated with eltrombopag(75 mg/d for 6 months)combined with antithymocyte immunoglobulin(ATG): rabbit ATG 3.5 mg/(kg·d)× 5 days or porcine ATG 30 mg/(kg·d)× 5 days and cyclosporine A(Cs A),with serum concentration be maitained from 150 to 200 ng/ml.The efficacy and tolerability were evaluated.Results: The effective rates in the 1st month,the 3rd month,the 6th month,the 9th month after treatment were 13.3%,46.2%,54.6% and 60%,respectively.The white blood cell,platelet count,level of hemoglobin and reticulocyte counts were significantly improved(P<0.05).The percentage of Treg also increased significantly(P=0.007).Liver and kidney function were monitored and maintained in the normal range during the treatment.Elderly patients(≥70 years old)and high Charlesson index(≥5 points)had poor efficacy(60% vs 40%,P=0.011;73.3% vs 26.7%,P=0.033).Conclusion: The use of eltrombopag in combination with ATG+Cs A in elderly patients with SAA may be effective,and the patients tolerate it well.It is worthy of further exploration of this regimen.This protocol does not lead to an excellent prognosis for patients of advanced age or with high scores on Charlson Comorbidity Index.New protocols need to be searched for.