ArticleAnnals of hematology2025
The efficacy of immunosuppressive therapy with or without thrombopoietin receptor agonist in elderly patients with severe aplastic anemia.
Article in Annals of hematology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Haploidentical HSCT vs immunosuppressive therapy for severe aplastic anemia in patients aged 40-65 years: a retrospective comparative study.Stem cells translational medicine · 2026Article
- Development and validation of a nomogram for early prognostic prediction in childhood aplastic anemia receiving cyclosporine monotherapy.Pediatric research · 2026Article
- Review
- Umbilical cord blood infusion in the treatment of aplastic anemia: A single center prospective study.Scientific reports · 2025Article
- Rapid early remission in a patient with severe aplastic anemia: a case report of hetrombopag, cyclosporine, and danazol combination therapy.Frontiers in immunology · 2025Article
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Authors and funding
12 authors.
Funding
Abstract
Old individuals are at a high risk of developing aplastic anemia, and immunosuppressive therapy (IST) based on anti-human T-lymphocyte immunoglobulin (ATG) and cyclosporine (CsA) is recommended for treating severe aplastic anemia (SAA). Adding the thrombopoietin receptor agonist (TPO-RA) to IST could improve hematologic responses in patients with SAA; however, limited data exist for elder patients. Here, we report on the efficacy and prognostic factors associated with porcine ATG and CsA with or without TPO-RA as first-line therapy in elderly patients with SAA. Porcine ATG was administered intravenously at a dose of 20 mg/kg/d for 5 days. CsA was administered orally, maintaining plasma trough concentrations of 150-250 µg/L. Eltrombopag was administered at a dose of 75-150 mg/day, and hetrombopag was administered orally at a dose of 15 mg/day. One hundred and twenty-eight SAA patients, with a median age of 63 (60-73) years old, were included in this study, including 44 very severe aplastic anemia (VSAA) patients. All patients completed the porcine ATG treatment, and mild serum sicknesses were observed. Ten patients (2 SAA patients and 8 VSAA patients) died within 3 months of ATG initiation (early death), with severe infections being the main cause of death. Sixty-nine patients achieved a hematologic response at 6 months, with an overall response (OR) rate of 53.9%. The complete hematologic response (CR) rate at 6 months was 18.0%. The addition of TPO-RA to IST did not improve the OR and CR rates; nonetheless, early death was significantly lower (0%) in patients receiving TPO-RA compared to those not receiving TPO-RA (12%). Patients were followed up for a median of 28 (0.1-117) months. The OR rate at the last follow-up was 62.5%, while the CR rate was 36.7%. One patient progressed to myelodysplastic syndrome, one to leukemia, one to hemolytic paroxysmal nocturnal hemoglobinuria, and five developed clonal chromosomal abnormalities. The 2-year overall survival rate and failure-free survival rate were 86.0% (95% CI: 78.1-91.3%) and 70.5% (95% CI: 61.3-77.9%), respectively. A baseline neutrophil count of < 0.05 × 10
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