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重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究

OBJECTIVE: To explore the characteristics of delayed hematologic response in very/severe aplastic anemia (V/SAA) patients who were treated with immunosuppressive treatment (IST) as first-line approach, and investigate the rationality of early salvage treatment in refractory patients. METHODS: The da...

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Formato: Online Artículo Texto
Lenguaje:English
Publicado: Editorial office of Chinese Journal of Hematology 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348502/
https://www.ncbi.nlm.nih.gov/pubmed/28088966
http://dx.doi.org/10.3760/cma.j.issn.0253-2727.2016.12.006
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collection PubMed
description OBJECTIVE: To explore the characteristics of delayed hematologic response in very/severe aplastic anemia (V/SAA) patients who were treated with immunosuppressive treatment (IST) as first-line approach, and investigate the rationality of early salvage treatment in refractory patients. METHODS: The data of V/SAA patients front-line treated with IST were retrospectively analyzed. Delayed response was defined as acquiring hematologic response between 6 and 12 months after 1 course of IST. The clinical as well as hematologic characteristics of the delayed responded patients were investigated. RESULTS: Of the 533 patients, 45 (8.44%, 45/533) were delayed hematologic responders, which accounted for 29.03% (45/155) of the whole non-responders at 6 months. The quality of response in delayed responders analyzed at 12 months (χ(2)=62.616, P <0.001) and at the end of follow-up (χ(2)=6.299, P=0.043) was significantly worse than that of robust response group. There were more VSAA patients in delayed response group compared with robust response group (57.8% vs 38.3%, P=0.013), and all the baseline absolute reticulocyte (ARC) count, ARC proportion and absolute neutrophil count (ANC) were much lower than that in delayed response group. Multivariate analysis about the above 2 groups showed that the baseline ARC count <10×10(9)/L significanty reduced the chance of hematologic response within 6 months [OR=3.641(95% CI 1.718–7.719), P=0.001], and not any factor was found to predict delayed hematologic response in non-responders at 6 months. The 5-year overall survival of 76.50% (95% CI 71.6%–81.4%) and event free survival of 29.10%(95% CI 25.2%–33.0%) in non-responders at 6 months, both were worse than 97.6% (95% CI 96.6%–98.6%) and 84.0% (95% CI 81.1%–86.9%) (P <0.001) of robust response group. CONCLUSION: The incidence of delayed hematologic response in V/SAA patients by IST is low. The quality of delayed response is not satisfactory and there is no effective means to predict the delayed response. It is reasonable to carry out salvage treatment as early as possible.
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spelling pubmed-73485022020-07-16 重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究 Zhonghua Xue Ye Xue Za Zhi 论著 OBJECTIVE: To explore the characteristics of delayed hematologic response in very/severe aplastic anemia (V/SAA) patients who were treated with immunosuppressive treatment (IST) as first-line approach, and investigate the rationality of early salvage treatment in refractory patients. METHODS: The data of V/SAA patients front-line treated with IST were retrospectively analyzed. Delayed response was defined as acquiring hematologic response between 6 and 12 months after 1 course of IST. The clinical as well as hematologic characteristics of the delayed responded patients were investigated. RESULTS: Of the 533 patients, 45 (8.44%, 45/533) were delayed hematologic responders, which accounted for 29.03% (45/155) of the whole non-responders at 6 months. The quality of response in delayed responders analyzed at 12 months (χ(2)=62.616, P <0.001) and at the end of follow-up (χ(2)=6.299, P=0.043) was significantly worse than that of robust response group. There were more VSAA patients in delayed response group compared with robust response group (57.8% vs 38.3%, P=0.013), and all the baseline absolute reticulocyte (ARC) count, ARC proportion and absolute neutrophil count (ANC) were much lower than that in delayed response group. Multivariate analysis about the above 2 groups showed that the baseline ARC count <10×10(9)/L significanty reduced the chance of hematologic response within 6 months [OR=3.641(95% CI 1.718–7.719), P=0.001], and not any factor was found to predict delayed hematologic response in non-responders at 6 months. The 5-year overall survival of 76.50% (95% CI 71.6%–81.4%) and event free survival of 29.10%(95% CI 25.2%–33.0%) in non-responders at 6 months, both were worse than 97.6% (95% CI 96.6%–98.6%) and 84.0% (95% CI 81.1%–86.9%) (P <0.001) of robust response group. CONCLUSION: The incidence of delayed hematologic response in V/SAA patients by IST is low. The quality of delayed response is not satisfactory and there is no effective means to predict the delayed response. It is reasonable to carry out salvage treatment as early as possible. Editorial office of Chinese Journal of Hematology 2016-12 /pmc/articles/PMC7348502/ /pubmed/28088966 http://dx.doi.org/10.3760/cma.j.issn.0253-2727.2016.12.006 Text en 2016年版权归中华医学会所有 http://creativecommons.org/licenses/by-nc-sa/3.0/ This work is licensed under a Creative Commons Attribution 3.0 License (CC-BY-NC). The Copyright own by Publisher. Without authorization, shall not reprint, except this publication article, shall not use this publication format design. Unless otherwise stated, all articles published in this journal do not represent the views of the Chinese Medical Association or the editorial board of this journal.
spellingShingle 论著
重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究
title 重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究
title_full 重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究
title_fullStr 重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究
title_full_unstemmed 重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究
title_short 重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究
title_sort 重型再生障碍性贫血免疫抑制治疗迟发血液学反应研究
topic 论著
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348502/
https://www.ncbi.nlm.nih.gov/pubmed/28088966
http://dx.doi.org/10.3760/cma.j.issn.0253-2727.2016.12.006
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