The Clinical Study Of Cyclosporine Combined With Eltrombopag For The Treatment Of Aplastic Anemia

ObjectiveTo compare the hematological response(HR)and survival data of cyclosporine(CsA)± androgen and CsA+eltrombopag(EPAG)± androgen,and the efficiency and prognostic factors of CsA+EPAG for the treatment of AA were explored.MethodsAnalyze the clinical characteristics of 149 patients who were initially diagnosed with aplastic anemia(AA)in The First Affiliated Hospital of Zhengzhou University from September 2018 to September 2021,according to different treatment methods they were divided into CsA± androgen group and CsA+ EPAG±androgen group,according to the severity of the disease,they were divided into very severe aplastic anemia(VSAA),severe aplastic anemia(SAA)and non-severe aplastic anemia(NSAA).The clinical data were analyzed by SPSS26.0,correlation analysis was performed by unconditional Logistic regression analysis,Kaplan-Meier survival curve was used for survival analysis,Log-rank test was used for comparison,COX proportional hazard model was used for multivariate survival analysis,P<0.05 indicated that the difference was statistically significant.Results1.Among the 149 cases of AA patients,there was no gender difference in the incidence of AA.In non standard immunosuppressive treatment(IST),the use of CsA ± androgen was relatively common,the CsA+EPAG ±androgen regimen was relatively rare,and the selection trends among different types of AA was also different.2.For SAA/VSAA,compared with CsA monotherapy,there was no significant difference in the 3-month complete response rate and overall response rate on CsA+EPAG.The 6-month complete response rate was significantly increased,the difference was statistically significant.Although the overall response rate showed an upward trend,it was not statistically significant.Combined androgen therapy was not the influencing factor of 6-month complete response rate.ANC≤0.2×10~9/L and 3-month hematological response were independent influencing factors for 6-month complete hematological response for CsA treatment,while ANC≤0.2 × 10~9/L was not independent influencing factor for CsA+EPAG.3.For NSAA,compared with CsA monotherapy,the overall response rate of 3 months combined EPAG showed an increasing trend,but there was no statistical significance.After 6 months of combined treatment,all 7 patients obtained hematological response,and the complete response rate and overall response rate showed an upward trend,but there was no statistical difference.4.There were significant differences in 2-year overall survival and progressionfree survival between SAA/VSAA and NSAA patients.For SAA/VSAA,age>60 years,inflection,6-month hematologic response was an independent influencing factor for overall survival.ANC≤0.2 × 10~9/L,hepatic dysfunction and 6-month hematologic response was an influencing factor for progression-free survival.For NSAA,failure to achieve hematologic response at 6 months was an independent risk factor for overall survival,while hepatic dysfunction and 6-month hematologic response were independent factors for progression-free survival.5.For SAA/VSAA and NSAA,compared with CsA monotherapy,CsA+ EPAG therapy was not an influencing factor for overall survival and progression-free survival,and androgen therapy was not an influencing factor for overall survival and progression-free survival.Conclusions1.For SAA/VSAA,CsA+EPAG±androgen therapy significantly increased the 6-month complete response rate,but did not affect overall survival and progressionfree survival.2.For NSAA,3-month and 6-month overall response rate improved for CsA+EPAG+androgen,but there was no statistically significant difference,and did not affect overall survival and progression-free survival.3.In SAA/VSAA group,the 3-month hematologic response is an independent influencing factor for CsA+EPAG ± androgen therapy to reach 6-monoth complete response,and 6-month hematologic response is an independent influencing factor for overall survival and progression-free survival of SAA/VS AA and NSAA.