Clinical Analysis Of 146 Cases Of Non-severe Aplastic Anemia In Multicenter

Objective:The aim of this article is to investigate whether non-severe aplastic anemia(NSAA)requires early immune intervention therapies and to evaluate whether cyclosporine A(CsA)combined with antithymocyte globulin(ATG)is more effective than cyclosporine A alone in the treatment of non-severe aplastic anemia(NSAA),and determine if patients can benefit from this treatment plan,analyze factors that may affect prognosis,so that we can better understand the disease,improving outcome of patients,and raising overall survival rate.Methods:The study retrospective analysis of the 146 NSAA patients treated with CsA or CsA combined with ATG were from September 2006 to September 2015 in the First Hospital of Jilin University(33 cases)and The First Affiliated Hospital of Zhejiang Chinese Medical University(52 cases)and the First Affiliated Hospital of Nanjing Medical University(61 cases).The follow-up deadline was January 2017.Data analysis using SPSS22.0,Measurement data were compared between groups by t-test and rank-sum test.Count data were analyzed by ?2 test or Fisher exact test.Coxregression model was used for multivariate analysis,and Kaplan-Meier analysis was used to estimate the overall survival rate.P values below 5% were considered statistically significant.Patients' gender,age,hemoglobin,absolute neutrophil counts,platelets,Transfusion situation,and onset to treatment interval were included in the analysis.Results:1.146 cases of NSAA patients included 77 male and 69 female,median diagnostic age was 31.5 years(3 to 86 years).There were 112 cases of transfusiondependent NSAA,and 34 cases of transfusion-independent NSAA.Onset to treatment interval ?6 months was 48 cases,6 months to 3 years was 52 cases,and>3 years was 46 cases.98 cases were treated with CsA and 48 cases were treated with CsA combined with ATG.2.Analysed from different onset to treatment interval showed that,there were significant statistical differences in effective rate,progression,and NR(all P values were<0.05).The effective rate between the onset to treatment interval?6 months group was significantly higher than the 6 months to 3 years group and>3 years group,and the NR and progression were lower than the 6 months to 3 years group and>3 years group.EFS between onset to treatment interval?6 months group was significantly longer than the 6 months to 3 years group and>3 years group(P=0.0002);OS of onset to treatment interval?6 months group was better than>3 years group(P=0.0311),and there was no statistically significant difference between the onset to treatment interval of?6 months group and 6 months to 3 years group,6 months to 3 years group and>3 years group.3.The comparison between transfusion-independent NSAA and transfusiondependent NSAA showed that there was no significant difference in the choice of treatment between the two groups(P=0.305).The progress rate of transfusiondependent NSAA was higher than transfusion-independent NSAA(P=0.007),and there was no significant difference in CR,PR,efficient,and death between the two groups.The EFS of transfusion-independent NSAA was significantly longer than transfusion-dependent NSAA(P=0.0042),but the difference in OS between the two groups was not statistically significant(P=0.0844).4.Compared the CsA group and the ATG combined with CsA group showed that There was a significant difference in the age of diagnosis between the two groups(P=0.001).The age of diagnosis in the CsA combined with ATG group was lower than the CsA group.The efficacy of CsA combined with ATG group was better than that of CsA group(P<0.05).The EFS of the CsA combined with ATG group was significantly longer than the CsA group(P= 0.0024),and there was no significant difference in OS between the two groups(P= 0.2193).5.Analysised of clinical efficacy and influencing factors: In the 146 NSAA patients,14 were CR(9.6%),51 were PR(34.9%),81 were NR(55.5%),age,onset to treatment interval,and therapies were significantly related to the efficacy(P<0.05).Diagnostic age?30 years,onset to treatment interval?6months,and CsA combined with ATG were all relevant with good efficacy.6.Survival analysis was performed on 146 NSAA patients: median EFS and median OS were not reached,1 year EFS was 72.5%,1 year OS was 98.6%;5 years EFS was 66.9%,5 years OS was 89.7%.The multi-factor analysis showed that onset to treatment interval,blood transfusion,and therapies were independent poor prognostic factors for EFS,and only onset to treatment interval > 3 years were independent poor prognostic factors affecting OS.The incidence of adverse reactions in the CsA group and CsA combined with ATG group were 61.2%(60/98)and 75%(36/48),and the incidence of adverse events was not statistically different between the two groups(P= 0.099).Conclusions:1.NSAA showed a good response to early immune intervention therapy(onsetto-treatment interval ?6 months),the effective rate was significantly higher than patients with onset to treatment interval >3 years,and the progression rate was significantly reduced.2.Compared with transfusion-independent NSAA,EFS was significantly shortened in transfusion-dependent NSAA,but there was no significant difference in efficacy and overall survival between the two groups.3.The combined use of CsA and ATG showed better CR rate and PR rate than CsA.There was significant difference in event-free survival between the two groups,but no significant difference in overall survival between the two groups.4.Factors affecting clinical efficacy include diagnostic age,onset to treatment interval,and therapies.5.onset to treatment interval,blood transfusion,and treatment plan are independent prognostic factors for EFS in NSAA patients,and only onset to treatment is independent prognostic factors of OS.