| Popis: |
Objectives: This study aims to compare clinical parameters and outcomes between patients with aplastic anaemia undergoing immunosuppressive treatment (IST) who received more than 10 units of blood components prior to IST and those who did not. Methods and materials: This cross-sectional study included patients diagnosed with aplastic anaemia and treated at Hospital Geral de Fortaleza. The treatment regimen comprised anti-thymocyte globulin, cyclosporine, and, in some cases, eltrombopag. Data were collected on various clinical parameters, including age, time to IST, haemoglobin (Hb), white blood cell count (Wbc), neutrophils (Neut), lymphocytes (Linf), platelet count (Plat), creatinine (Cr), urea (Ur), and lactate dehydrogenase (LDH). Patients were divided into two groups based on whether they received more than 10 transfusions before IST. Variables were summarised using medians and interquartile ranges (IQR). Comparisons between groups were evaluated using non-parametric tests, specifically the Mann-Whitney U-test, with p-values < 0.05 considered statistically significant. Overall survival (OS) was assessed using the Kaplan-Meier method, with a 95% confidence interval and p-values < 0.05 deemed statistically significant. Results: Between 2021 and 2024, 11 patients were diagnosed with aplastic anaemia and deemed suitable for IST. Patients who did not receive more than 10 transfusions had a median age of 20 years (IQR: 20-26.5), compared to 40.5 years (IQR: 35.5-42) for those who did. Time to IST was shorter for the transfusion group, with a median of 21 days (IQR: 11.5-25) versus 44 days (IQR: 34-54) for the non-transfusion group. The transfusion group had lower median levels of Hb (4.8 g/dL), WBC (1250 cells/μL), Neut (77 cells/μL), and plat (10500 cells/μL). Cr and urea levels were slightly higher in the transfusion group, with medians of 0.88 mg/dL and 35 mg/dL, respectively. LDH data were unavailable for the transfusion group. Only two patients received eltrombopag. There was no significant difference between the two groups in terms of age, blood count values at diagnosis, and sex (U-test > 0.05). Overall survival was 75%, with better outcomes in patients who had fewer than 10 transfusions, although this difference was not statistically significant (p-value: 0.257). Discussion: The analysis revealed significant clinical differences between the two groups. Patients who received more transfusions were older, had a shorter time to treatment initiation, and exhibited worse cytopenias. Although Cr and Ur levels were slightly higher in the group with more transfusions, LDH data were unavailable. Only two patients received eltrombopag, and there was no significant difference between the groups in terms of age, blood count values at diagnosis, and sex. The overall survival rate was 75%, with better outcomes in patients who had fewer transfusions, although this difference was not statistically significant. These findings suggest that multiple transfusions before IST may be associated with a more severe clinical profile, yet they do not significantly impact overall survival. Conclusion: The overall survival observed in this study was lower than international data. There was no significant difference between the groups analysed; however, the low patient count in the study should be considered when interpreting the lack of impact on outcomes. The use of IST with eltrombopag should be evaluated sequentially to determine its impact on individuals treated within the public health system. |
