Analysis Of Treatment And Outcome Of 79 Patients With Non-severe Aplastic Anemia

Objective:This article reviewed and summarized the clinical data, prognosis of disease and surviving survival state of patients with non-severe aplastic anemia(NSAA) in the Department of Cancer Center of the First Hospital of Jilin University, which could provide objective evidences for the treatments and prognosis of disease of NSAA.Methods:This study included 79 patients with NSAA diagnosed in our hospital from September 2015 to January 2011. The clinical data of 79 cases were reviewed and analysed. At the same time, the cases were followed up and observed curative effect and survival state. The data were statistically analyzed by Kolmogorov-Smirnov test, t test, Mann-Whitney non parametric test, variance analysis, Cox regression, Kaplan-Meier analysis.Results:1. There were 226 cases of AA patients were diagnosed during the 4 years, of which 79(35%) were NSAA. 79 cases of NSAA included 45 male and 34 female. There were 21 cases of transfusion-independent NSAA, and 58 cases of transfusion-dependent NSAA. Among the 79 cases of NSAA, the main therapeutic regimen was cyclosporine( 64.6%). Then therapeutic regimen were Antithymocyte Globulin(ATG) combined with cyclosporine and mainly treated with androgen, each percent was 12.7%. The percent of supportive treatment was 7.5% and the hematopoietic stem cell transplantation was 2.5%. The effective rate of NSAA after receiving treatment was 26.6%.2. The transfusion-dependent NSAA compared with transfusion-independent NSAA, the result showed that, the drug therapy of the two groups respectively was 19% and 3.4%, and significant difference(P = 0.021). There was more choose drug therapy in the transfusion-dependent NSAA than transfusion-independent NSAA. No significant difference in curative effect, outcomes of disease and overall survival between the two groups.3. The diagnostic age was(38.43±17.95) years in the cyclosporine group and(20.90 ± 12.56)years in the ATG combined with cyclosporine group. There was significant difference between the two groups(P=0.040). Comparied with curative effect and outcomes of the ATG combined with cyclosporine group and the cyclosporine group, the difference of NR, CR and effective rate was statistically significant. There was significant difference(all P <0.05). The CR and the effective rate of ATG combined with cyclosporine group was higher than that of the cyclosporine group, NR lower than the cyclosporine group. The effective rates of the cyclosporine group and the ATG combined with cyclosporine group at 3 months, 6 months and 12 months, respectively were 2% and 30%, 13.7% and 60%, 21.6% and 70%. The difference was statistically significant. There was significant difference(all P <0.05). The effective rates of the ATG combined with cyclosporine group was higher than the cyclosporine group at 3 months, 6 months and 12 months.4. Analysed the factors of curative effect of the cyclosporine group showed that, the factors of influencing the curative effect included the diagnostic age, the initial diagnosis of white blood cells(WBC), platelet(PLT), reticulocyte count(Ret). The diagnostic age ≤ 35 years, the initial diagnosis of WBC >2.5x109 /L, PLT≥15x109/L, Ret ≥20x109 /L, were all the related factor for a favourable result. Analysed the factors of curative effect of the ATG combined with cyclosporine group showed that, the factors of influencing the curative effect included the initial diagnosis of Ret. The initial diagnosis of Ret ≥20x109 /L, was the related factor for a favourable result.5. Among the 79 cases of NSAA, the OS at 1 year and 3 years respectively were 97.4% and 88%. Kaplan-Meier analysis showed that the related factors of influencing the OS was the diagnostic age. The diagnostic age ≤35 years was the factor influencing the OS for a favourable result. Comparied the OS of cyclosporine group and the ATG combined with cyclosporine group showed that, the OS of two group at 1 year and 3 years respectively were 98.0% and 100%, 90.1% and 100%,. The difference is not statistically significant(all P > 0.05).Conclusions:1. The main therapeutic regimen of NSAA was cyclosporine. The effective rate after receiving treatment was poor.2. There was more choose drug therapy in the transfusion-dependent NSAA than transfusion-independent NSAA. There was no significant difference in curative effect, outcomes of disease and overall survival between the two groups.3. The CR and effective rate of the ATG combined with cyclosporine group was higher than that of the cyclosporine group. However, the overall survival of two groups had no significant difference.4. The factors influencing the curative effect of the cyclosporine included the diagnostic age, the initial diagnosis of WBC, PLT, Ret. The factors influencing the curative effect of the ATG combined with cyclosporine included the initial diagnosis of Ret.5. The related factors of influencing the overall survival was the diagnostic age.