Safety and efficacy of immunosuppressive therapy for elderly patients with severe aplastic anaemia

Prabahran, A; Durrani, J; Coelho-Da Silva, J; Shalhoub, R; Lotter, J; Rios, O; Ritchie, DS; Wu, CO; Patel, BA; Young, NS; Groarke, EM

Author(s): Prabahran, A; Durrani, J; Coelho-Da Silva, J; Shalhoub, R; Lotter, J; Rios, O; Ritchie, DS; Wu, CO; Patel, BA; Young, NS; Groarke, EM;
Details: Publication Year 2024-09,Volume 205,Issue #3,Page 1170-1179
Journal Title: British Journal of Haematology
Publication Type: Research article
Abstract: Uncertainty remains regarding the safety and tolerability of immunosuppressive therapy (IST) with anti-thymocyte globulin (ATG) and cyclosporine (CSA) in older patients. We retrospectively analysed two prospective clinical trials of IST in treatment-naïve severe aplastic anaemia (SAA) to assess safety in older compared to younger patients. Patients ≥18 years of age who had received IST with ATG and CSA +/- eltrombopag (EPAG) were included. Pre-treatment baseline characteristics and co-morbidities were assessed as predictors of therapy-related complications in younger (<60 years) versus older (≥60 years) patients. Out of 245 eligible patients, 54 were older and 191 were younger. Older patients had a similar frequency of SAEs, ICU admissions and hospital length of stay compared to younger patients. Older patients had a higher frequency of cardiac events related to IST, but none resulted in death. Older patients had worse long-term overall survival, and more relapse and clonal evolution post-IST. However, older patients who responded to IST had a similar survival at a median follow-up to younger patients. Disease-related factors and limited therapeutic options in refractory disease likely contribute to poorer outcomes in older patients, not complications of upfront IST. Therefore, IST should be considered first-line therapy for most older SAA patients.
Publisher: Wiley
Keywords: Humans; *Anemia, Aplastic/drug therapy/mortality; Male; Female; Aged; Middle Aged; *Immunosuppressive Agents/therapeutic use/adverse effects; *Cyclosporine/therapeutic use/adverse effects; *Antilymphocyte Serum/therapeutic use/adverse effects; Retrospective Studies; Adult; *Hydrazines/therapeutic use/adverse effects; Age Factors; Pyrazoles/therapeutic use/adverse effects; Benzoates/therapeutic use/adverse effects; Treatment Outcome; Young Adult; Aged, 80 and over; Adolescent; aplastic anaemia; elderly patients; immunosuppression
Department(s): Haematology
Publisher's Version: https://doi.org/10.1111/bjh.19648
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-01-09 06:41:12

Last Modified: 2025-01-09 06:41:28