Effectiveness and safety of tacrolimus with or without eltrombopag, as a part of immunosuppressive treatment of aplastic anemia in adults: a retrospective case series

Experience of life quality from patients with aplastic anemia: a descriptive qualitative study

BACKGROUND

Despite the increasing incidence of aplastic anemia in China, few studies have explored its effect on the patients' quality of life from the perspective of these patients. In fact, patients with aplastic disorder live with the disease for a long time, and need to face a variety of difficult realities, including multiple disease symptoms and drug side effects, heavy burden of medical costs, difficulties in social reintegration, and negative emotional distress. Therefore, this study used descriptive qualitative research to explore the direct and rich quality-of-life experiences of patients with aplastic anemia.

METHODS

A total of 19 patients with aplastic anemia were recruited in this study using purposive sampling combined with maximum variation strategy. 5 of the patients with AA were from northern China, and the others were from southern China. Data were collected using semi-structured interviews and analyzed using the conventional content analysis method.

RESULTS

This study yielded important information about the experiences of patients with aplastic anemia in China. The content analysis method finally identified 3 themes and 9 sub-themes, including: physical symptoms (declining physical capacity, treatment-related symptoms, changes in body image), psychological symptoms (mood changes related to the stage of the disease, change in self-image, growth resulting from the disease experience), social burden (decline in career development, perceived burden to the family, social stigma). Patients with AA from different regions didn't show much difference in quality of life.

CONCLUSIONS

Aplastic anemia affects the physical, psychological, and social aspects of patients' lives. Therefore, health care providers need to consider the patients' physical response and psychological feelings to provide relevant medical guidance and multi-channel social support that would improve their confidence and quality of life.

CLINICAL TRIAL REGISTRATION

Name: Development and preliminary application of Quality of Life Scale for Patients with Aplastic Anemia. Number: ChiCTR2100047575. URL: http://www.chictr.org.cn/login.aspx?referurl=%2flistbycreater.aspx .

Severe infections and renal dysfunction during immunosuppressive therapy with cyclosporine A for aplastic anemia

Although immunosuppressive therapy (IST) with cyclosporine A (CyA) has been widely used in patients with aplastic anemia (AA), little attention has been given to its safety. This study aimed to clarify the adverse events of IST in patients with AA. We retrospectively identified 42 patients with AA treated with IST. Seventeen of the 42 patients (40%) experienced severe infection at a median of 142 days from the start of IST, and 18 (49%) experienced renal dysfunction at a median of 73 days. A large proportion of infected patients had severe AA (90 vs. 14%, p = 0.056). Notably, all patients with severe infection showed poor response to IST at the time of infection onset. Analysis regarding risk factors for renal dysfunction showed that median age at the initiation of IST was significantly higher in patients with renal dysfunction than those without renal dysfunction (65 years vs. 44 years, p = 0.020). Only 2 of 18 patients showed improvement in serum creatinine levels despite reduction or discontinuation of CyA. Our results suggest that poor responders to IST and elderly patients are at higher risk of severe infection and renal dysfunction, respectively.

New Trends of Nontransplant therapy for Acquired Aplastic Anemia

Aplastic anemia (AA) is a hematological disease that is characterized by pancytopenia and hypofunctional bone marrow hematopoiesis. Patients with AA are treated with either immunosuppressive therapy (IST) using anti-thymocyte globulin (ATG) and Cyclosporine (CsA) or hematopoietic stem cell transplantation (HSCT), if a matched donor is available. The standard IST regimen for AA patients which results in response rates up to 70%, and even higher overall survival. However, primary and secondary failures after IST remain frequent, and to date all attempts aiming to overcome this problem have been unfruitful. The nontransplant therapeutic options for AA have significantly expanded during the last few years. Here, we review the new trends of nontransplant therapy for AA and summarize the current therapeutic effect of AA.