Single Center Treatment Mode And Effectiveness Analysis Of Severe Aplastic Anemia

Objective：HSCT and IST were two standard treatment in patients with severe aplastic anemia,but some of these issues are still controversial or inconclusive, as a result, we sorteddata in our center of aplastic anemia patients, analysed effectiveness andcomplications after treatment with HSCT and IST, compared treating effect of rabbitATG and pig ALG、different transplantation ways in HSCT.Method:The clinical data of102cases (IST39cases and HSCT63cases) with severe aplasticanemia and very severe aplastic anemia in hematology department from January2004to October2013were retrospectively analyzed, to compare the overall effectiveness(overall survival) after the therapy in HSCT and IST(ALG/ATG+CsA), to compareeffectiveness and complications (infection, acute graft versus host disease, chronicgraft versus host disease) with different transplantation ways in HSCT. Weadopted independent sample t-test to compare different groups. GraphPad Prism5statistical software to make survival curve, the log-rank test compared differencesbetween groups, P <0.05was statistically significant, P <0.01, significant statisticalsignificance.Results:1. Survival rate was95%and84%for patients treated with HSCT and IST,respectively (p=0.12). By age group,≤19years old，IST and HSCT group OSwere91%and90%respectively (P=0.90);20to39years old age group were91%and96%, respectively (P=0.30);40or higher,40%and100%, respectively(P=0.045). According to the severity of disease group, OS of two kinds oftreatment in SAA were90%、100%respectively(P=0.071)，in VSAA were66%、91%（P=0.16）.IST、HLA non-identical and HLA identical were85%、86%and 85%respectively (P=0.13).2. In IST group, survival rate was91%for patients≤19years old and20～39yearsold, survival rate was40%for patients over40years old(P=0.13), patients withSAA and VSAA OS were90%and66%respectively (P=0.18).3. HSCT group, survival rate was100%for patients over40years old, survival for≤19years old and20～39years old were90%and96%respectively (P=0.42).Patients with SAA and VSAA OS were100%and91%respectively (P=0.087).4. IST treatment group, the swine ALG (n=23) and rabbit ATG (n=16) infectionprobability was26.1%、56.2%, respectively (X2=3.63, P=3.63), fever21.7%、56.2%(X2=4.88, P=0.027), the rash was0%、25%, hypertension was0%、9.1%, serum disease was30.4%、12.5%(X2=1.71, P=0.18)。5. HSCT groups, HLA non-identical(n=15)and HLA identical(n=48) infectionprobability was60%、50%, respectively (X2=0.46, P=0.49), acute graft versushost disease probability was53.3%、18.75%(X2=6.94, P=0.008), chronicgraft versus host disease probability was20%、25%(X2=0.53, P=0.47).6. Cost comparison: the medical cost in HSCT group (RMB227503.8) was higherthan IST group (RMB186168.4)(P=0.049), HLA non-identical(RMB307641.7)and HLA identical group (RMB215006.3) were higher than ISTgroup(P=0.01,P=0.17), HLA non-identical is higher than HLA identicalgroup(P=0.13).Conclusion：1. The incidence of infection, fever, high blood pressure, skin rash with swine ALGwas lower than rabbit ATG.2. Haploidentical HSCT did not increase the incidence of infection, but aGVHDincidence was obviously higher than the MSD-HSCT.3. There was no obvious significant difference of survival rate between IST andHSCT (haploidentical and MSD), if there was a histocompatible donor, MSD-HSCT should be the preferred therapy，but patients who older than40yearsold，had a bad ending.4. HSCT group (including haploidentical) cost was higher than IST treatment group,There was no obvious significant difference of cost between haploidentical groupand MSD group.