Effectiveness of Immunosuppressive Therapy in Older Patients with Aplastic Anemia

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Abstract
Immunosuppressive therapy has been used for successful treatment of severe aplastic anemia, but little information is available on outcome in older patients. To evaluate outcome in patients older than 50 years of age who received immunosuppressive therapy for aplastic anemia. Retrospective cohort study. 56 centers of the European Group for Blood and Marrow Transplantation (EBMT). 810 patients with aplastic anemia reported between 1974 and 1997. Patients were evaluated according to age group: 60 years of age or older (n = 127), 50 to 59 years of age (n = 115), and 20 to 49 years of age (n = 568; reference group). Antilymphocyte globulin, cyclosporine, or both. Survival, cause of death, response to treatment, relapse rate, and risk for late complications were analyzed in all patients and by age group. The 5-year survival rate was 57% (95% CI, 46% to 66%) in patients 50 to 59 years of age and 50% (CI, 39% to 60%) in patients 60 years of age or older compared with 72% (CI, 68% to 76%) in patients younger than 50 years of age (P < 0.001). Response to therapy, relapse rate, and risk for clonal complications were similar in all three age groups (P > 0.2). Age was significantly associated with an increased risk for death (relative risk compared with patients 20 to 49 years of age, 1.80 [CI, 1.29 to 2.52] for patients 50 to 59 years of age and 2.57 [CI, 1.87 to 3.53] for patients ≥ 60 years of age), mainly because of bleeding or infection (P = 0.02). Response to immunosuppressive therapy in all patients at 12 months was 62% (CI, 58% to 66%); no difference was seen among the age groups in multivariate analysis (P > 0.2). Sixty-six of the 379 responding patients (17%) subsequently had relapse. The risk for clonal disorders at 10 years was 20% (CI, 15% to 27%). Response to immunosuppression in aplastic anemia is independent of age, but treatment is associated with increased mortality in older patients.