Predicting Early Response To Immunosuppressive Therapy In Severe Aplastic Anemia With Soluble Transferrin Receptor Assay

Objective To evaluated the application value of serum soluble transferrin receptor (sTfR) concentration in predicting early immunosuppressive therapy (1ST) response of severe aplastic anemia (SAA).Methods Clinical data and hematologic responses of140SAA patients treated with rabbit antithymocyte globulin (ATG) combine cyclosporine1ST regimen in our hospital were retrospectively analyzed. Correlation of pre-IST baseline sTfR and treatment results were statistically analyzed and receiver operating characteristic (ROC) curve was used to estimate the sensitivity and specificity of sTfR in predicting early1ST results.Results Serum concentration of sTfR in aplastic anemia were significantly lower than normal reference and the sTfR level were roughly correlated with bone marrow failure severity, with the very servere aplastic anemia patients possess the lowest sTfR concentration (P=0.001).64(45.7%) and78(55.7%) patients got hematologic response at3and6month after1ST respectively. The responded patients had significantly higher pre-IST baseline sTfR concentration than those non-responed. Baseline sTfR were0.89mg/L and0.58mg/L respectively in responded and non-responded patients when evaluated at3month after1ST (P=0.005). The cutoff level of0.91mg/L and0.88mg/L for the predicting3and6month1ST responses were established based on the ROC curve, with degree of accurancy of65%and60.7%respectively. Multivariate analysis showed that pretreatment serum sTfR value was the independent factor of predicting1ST treatment effect (at3month, P=0.007; at6-month, P=0.021).Conclusions sTfR can serve as one of the bone marrow failure severity indicators and a significant predictor of early1ST response in aplastic anemia.