Prognosis in acquired aplastic anemia. An approach in the selection of patients for allogeneic bone marrow Ttransplantation

Abstract

In a retrospective study, factors influencing the eventual course and outcome of patients suffering from aplastic anaemia were analysed. Of the 62 patients with pancytopenia concomitant with an aplastic or hypoplastic bone marrow, 36 have died during the first 24 months following diagnosis, 27 of these 36 cases within the first six months. 26 patients survived more than two years after presentation, but a further six of these cases succumbed during the following months. Of the 62 cases, 46 had neutrophil counts under 1 X 10(9)/l and platelet counts under 20 X 10(9)/l. These cases were subdivided according to their reticulocyte levels. In the age group of patients between 10 and 35 years, all those patients having more than 10,000/mul reticulocytes survived more than two years with only one exception, whereas only one of the 11 patients having reticulocyte counts below 10,000/mul has survived. In our series, the initial neutrophil and platelet counts were not of predictive value in identifying poor prognosis patients. The initial reticulocyte counts, however, appear to be a valid parameter for selecting patients in two groups, one with a favorable, and the other with an extremely unfavorable prognosis on conservative treatment. Young individuals with a poor predicted prognosis could thus be defined as possible candidates for bone marrow transplantation.

Aplastic Anemia: Assessment of Myeloid Progenitor Cells in the Bone Marrow and Blood Provides Prognostic Information

“…This finding, assumed to reflect two distinct disease categories, has led to attempts to subclassify patients at the begin of their disease by means of clinical fac tors, initial blood studies, or a combination of both. A rapid onset of disease and the presence of hemor rhagic symptoms is associated with diminished sur vival [4,5], as are low initial counts of neutrophils [4,6,7], platelets [4,6] or reticulocytes [2,4,6,8,9]. In our hands, an initial analysis of numbers of reticulo cytes proved impractical due to considerable day-today fluctuations.…”

Prognosis in Acquired Aplastic Anemia

“…0.1 x 109 neutrophils/1 and 5xl09 platelets/1 which form a prognostic system for identification of nonsurviving and sur viving patients beyond the first few months after diagnosis. In previous stud ies the reliability of prognostic systems be yond 3-6 months is controversial because they are based on the comparison of non survivors and survivors at diagnosis [Lohrmann et al, 1976;Hellriegel et al, 1977], At this moment, however, chronic courses with a fatal or favorable outcome cannot yet be distinguished. The evolu tionary tendency as a reliable measure for the chronic form of aplastic anemia was stressed in two recent reports.…”

Prediction of Survival in Adults with Acquired Bi‐ or Pancytopenia

“…This study could not demonstrate the significant predictive value of the duration of onset symptoms and the initial reticulocyte count, which have been consistent findings in some studies (2-4, 16, 17). Additionally a few studies, applying diverging dependent survival variables, have supported the predictive value of the reticulocyte count (21)(22)(23). However, this discrepancy is not serious, since trends towards lower values in short survivors were found for both of these 2 variables.…”