Immunosuppressive therapy in adults with aplastic anaemia: single-institution experience from India

Objective To determine overall survival and factors predicting survival after immunosuppressive therapy in patients with acquired aplastic anaemia. Design Retrospective. Setting Tertiary care hospital. Patients 120 adults diagnosed as having acquired aplastic anaemia between 1 January 1996 and 31 December 2009. Interventions Anti-thymocyte globulin (ATG) followed by ciclosporin was administered to all patients for 15-18months as the initial treatment. Haematological response was assessed 6months after ATG administration and 6-monthly thereafter. Platelets were transfused if levels were <10x10(3)/l and for symptomatic bleeding. Transfusions of red blood cells were given for haemoglobin levels <70g/l or symptomatic anaemia. Febrile neutropenia was managed with antibiotics, with the addition of antifungal agents after 3-4days of unresponsive fever. Granulocyte colony-stimulating factor was administered at a dose of 5 mu g/kg/day (maximum 300 mu g/day) subcutaneously for infective episodes. Main outcome measures Primary outcome: overall survival. Secondary outcome: response to immunosuppressive therapy, failure-free survival, relapse and clonal evolutions. The response and relapse criteria were defined in accordance with the British Council for Standards in Haematology guidelines. Results Overall response at 6months after initiation of treatment was 85.8% (103/120). Overall survival at 76months was 83.4%. Overall survival correlated with presence of response (complete response or partial response) at 6months after ATG administration (HR=0.021, 95% CI 0.006 to 0.079, p<0.001). The occurrence of infectious complications adversely affected the overall survival (HR=5.71, 95% CI 1.22 to 26.77, p=0.027). Six patients relapsed. There were no deaths or adverse events 12months after treatment among responders. Conclusions In our study, overall survival was 83.4% at a median follow-up of 76months. The two variables that significantly affected overall survival were response to therapy at 6months and occurrence of infectious complications.