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Haematologica. 2019 Feb;104(2):256-262. doi: 10.3324/haematol.2018.198440. Epub 2018 Sep 27.

Aplastic anemia in the elderly: a nationwide survey on behalf of the French Reference Center for Aplastic Anemia.

Author information

1
French Reference Center for Aplastic Anemia, CHU Saint Louis, Paris.
2
Hematology department, CHU Cochin, Paris.
3
Paris Descartes University, Sorbonne Paris Cité.
4
Medical informatics and biostatistics department, CHU Saint-Louis, Paris.
5
Department of biological hematology, CHU Necker, Paris.
6
Hematology department, Centre Henri Becquerel, Rouen.
7
Hematology department, CHU Saint-Louis, Paris.
8
Paris Diderot University.
9
Senior hematology department, CHU Saint-Louis, Paris.
10
Hematology department, CHU Necker, Paris.
11
Hematology department, CHU Amiens.
12
Hematology department, CHU Estaing, Clermont-Ferrand.
13
Clinical immunology department, CHU Lille.
14
Hematology department, CHU Lyon-Sud.
15
Hematology department, CH Côte Basque, Bayonne.
16
Hematology department, CHU Grenoble.
17
Biological hematology department, CHU Saint-Antoine.
18
Hematology department, CHU La Miletrie, Poitiers.
19
Hematology department, CHU Pitié-Salpêtrière, Paris.
20
Hematology department, CHU Strasbourg.
21
Bone-marrow transplantation department, CHU Saint-Louis, Paris.
22
Inserm UMR 1160, CHU Saint Louis, Paris, France.
23
French Reference Center for Aplastic Anemia, CHU Saint Louis, Paris regis.peffaultdelatour@aphp.fr.

Abstract

Aplastic anemia is a rare but potentially life-threatening disease that may affect older patients. Data regarding the treatment of aplastic anemia in this ageing population remains scarce. We conducted a retrospective nationwide multicenter study in France to examine current treatments for aplastic anemia patients over 60 years old. Our aims were to evaluate efficacy and tolerance, and to analyze predictive factors for response and survival. Over the course of a decade, 88 patients (median age 68.5 years) were identified in 19 centers, with a median follow up of 2.7 years; 21% had very severe and 36% severe aplastic anemia. We analyzed 184 treatment lines, mostly involving the standard combination of anti-thymocyte globulin and cyclosporine-A (33%), which was also the most frequent first-line treatment (50%). After first-line therapy, 32% of patients achieved a complete response, and 15% a partial response. Responses were significantly better in first line and in patients with good performance status, as well as in those that had followed an anti-thymocyte globulin and cyclosporine-A regimen (overall response rate of 70% after first-line treatment). All treatments were well tolerated by patients, including over the age of 70. Three-year survival was 74.7% (median 7.36 years). Age, Charlson comorbidity index and very severe aplastic anemia were independently associated with mortality. Age, per se, is not a limiting factor to aplastic anemia treatment with anti-thymocyte globulin and cyclosporine-A; this regimen should be used as a first-line treatment in elderly patients if they have a good performance status and low comorbidity index score.

PMID:
30262561
DOI:
10.3324/haematol.2018.198440
Free PMC Article

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