Predicting response to porcine antilymphocyte globulin plus cyclosporine A in children with acquired severe aplastic anemia

Abstract

Background

In severe aplastic anemia (SAA), predictive markers of response to immunosuppressive therapy (IST) of porcine antilymphocyte globulin (pALG) have not been well defined. We investigated whether clinical and laboratory findings before treatment could predict response in a pediatric cohort.

Methods

In this study, we included 70 newly diagnosed SAA children and treated them with pALG. The response rate was documented during follow-up. The log-rank test compared response rates between the potential predictive factors.

Results

The response rate was 57.1% at 24 months follow-up. In log-rank test, mild disease severity was the most significant predictive marker of better response (P < 0.001); SAA patients with higher absolute reticulocyte count (ARC) and platelet level showed a higher response rate (both P < 0.001). Although insignificantly, elderly children and male sex show better response rate after treatment. The response rate worsened when the time interval before IST was more than 60 days.

Conclusion

Modified IST with pALG was suitable for SAA children, and favorable response correlates with mild disease severity was identified. ARC and platelet status also appeared to be a reproducible prognostic model for response rate. IST should be started as soon as possible, given that the response rate worsens as the interval between diagnosis and treatment increases.

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Acknowledgements

We would like to acknowledge AiYou Foundation and patients for participating in the follow-up as well as those who provided feedback on the written information. This work was supported by the National Key Research and Development Program of China (2016YFC0901503) and the National Natural Science Foundation of China (81500156, 81170470).

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Correspondence to Xiao-Fan Zhu.

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Liu, L., Chen, X., Yang, W. et al. Predicting response to porcine antilymphocyte globulin plus cyclosporine A in children with acquired severe aplastic anemia. Pediatr Res 86, 360–364 (2019). https://doi.org/10.1038/s41390-019-0437-1

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