| ObjectivePNH clones,also aptly called"escape clones",are evidence of acquired immune-mediated bone marrow failure and have a high prevalence in aplastic anemia patients.Several studies have reported contradictory results regarding the impact of PNH clones on AA patients with immunosuppression treatment,and PNH clones have not been confirmed as positive predictors of response in the AA guidelines of the British Society for Standards in Haematology.MethodHere,we performed a meta-analysis to address this issue by searching for articles in PubMed,EMBASE,The Cochrane Library,Web of Science and ClinicalTrials.gov and for abstracts from the American Society of Hematology and the European Hematology Association annual meetings.We included 1236 participants from 11 cohort controlled studies.Our primary outcome was the 6-month hematologic response with a secondary outcome of the mortality rate within 3 months.ResultsA better response rate was observed in the PNH+group than in the PNH-group(OR=2.85 with a 95%CI of 2.17-3.75,P<0.00001),and further subgroup analysis strengthened the outcome,with minor heterogeneity in non-Asia.In contrast,the early mortality was not significantly different between the PNH+and PNH-groups(OR=0.54 with a 95%CI of 0.26-1.10,P=0.09).Conclusion The meta-analysis suggested an evidence-based role for PNH clones in predicting better response in AA patients with immunosuppression. |
