AUTHOR=Wang Ting , Wang Chaomeng , Liu Chunyan , Shao Zonghong , Fu Rong 

TITLE=Partial SAA patients benefit from delayed response of IST

JOURNAL=Frontiers in Immunology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2023.1067977

DOI=10.3389/fimmu.2023.1067977

ISSN=1664-3224

ABSTRACT=<sec><title>Introduction</title><p>Severe aplastic anemia(SAA)is a severe disease characterized by immune-mediated bone marrow failure and pancytopenia. Immunosuppressive therapy (ATG plus CsA, IST) is the standard treatment for patients who are not suitable for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Some patients have a delayed response after 6 months of ATG, and unnecessary to be given secondary ATG or allo-HSCT. We attempted to distinguish patients who may get potential delayed response from those who were really not responsive to IST.</p></sec><sec><title>Methods</title><p>We collected data from 45 SAA patients who were assessed no-response to IST at 6 months after rATG and failed to receive secondary ATG or allo-HSCT.</p></sec><sec><title>Results</title><p>CsA plus eltrombopag (EPAG) group has an extra 75% response rate while CsA maintenance group has an extra 44% response rate at 12 months. ATG was applied within 30 days after diagnosis, ATG dosage was suffificient (ATG/lymphocyte ≥2), and absolute reticulocyte count (ARC) was ≥30×109 /L at 6 months, indicated patients could get delayed response and benefifit from CsA maintenance. Addition of EPAG could give an even better response. Otherwise, secondary ATG or allo-HSCT treatment were recommended to be given immediately.</p></sec><sec><title>Clinical Trial Registration</title><p><uri xlink:href="https://www.chictr.org.cn/searchproj.aspx" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.chictr.org.cn/searchproj.aspx</uri>, identifier ChiCTR2300067615.</p></sec>