[Reassessing the six months prognosis of patients with severe or very severe aplastic anemia without hematological responses at three months after immunosuppressive therapy].

To reassess the predictors for response at 6 months in patients with severe or very severe aplastic anemia (SAA/VSAA) who failed to respond to immunosuppressive therapy (IST) at 3 months. We retrospectively analyzed the clinical data of 173 patients with SAA/VSAA from 2017 to 2018 who received IST and were classified as nonresponders at 3 months. Univariate and multivariate logistic regression analysis were used to evaluate factors that could predict the response at 6 months. Univariate analysis showed that the 3-month hemoglobin (HGB) level (=0.017) , platelet (PLT) level (=0.005) , absolute reticulocyte count (ARC) (<0.001) , trough cyclosporine concentration (CsA-C0) (=0.042) , soluble transferrin receptor (sTfR) level (=0.003) , improved value of reticulocyte count (ARC(△)) (<0.001) , and improved value of soluble transferrin receptor (sTfR(△)) level (<0.001) were related to the 6-month response. The results of the multivariate analysis showed that the PLT level (=0.020) and ARC(△) (<0.001) were independent prognostic factors for response at 6 months. If the ARC(△) was less than 6.9×10(9)/L, the 6-month hematological response rate was low, regardless of the patient's PLT count. Survival analysis showed that both the 3-year overall survival (OS) [ (80.1±3.9) % (97.6±2.6) %, =0.002] and 3-year event-free survival (EFS) [ (31.4±4.5) % (86.5±5.3) %, <0.001] of the nonresponders at 6 months were significantly lower than those of the response group. Residual hematopoietic indicators at 3 months after IST are prognostic parameters. The improved value of the reticulocyte count could reflect whether the bone marrow hematopoiesis is recovering and the degree of recovery. A second treatment could be performed sooner for patients with a very low ARC(△).