Photo Credit: ALIOUI Mohammed Elamine

Despite advances in treatment, older patients with aplastic anemia (AA) continue to have poorer outcomes, according to findings published in the American Journal of Hematology. Bruno Fattizzo, MD, and colleagues retrospectively analyzed 1,113 patients. A total of 319 (29%) patients were older than 60 at diagnosis, with 85 aged 60-64 years, 106 aged 65-69 years, and 128 aged older than 70 years. Compared with younger patients, older patients had more severe thrombocytopenia at AA onset and a significantly lower overall response rate to first-line therapy at six months (47% vs 65%, P<0.0001), regardless of treatment type. Among older patients, 27 (8%) underwent transplantation as second-line therapy, with 11 (41%) dying due to transplant-related complications. The incidence of progression to myelodysplastic syndrome was higher in older patients (12% vs 7%, P=0.002), while progression to acute myeloid leukemia was similar between age groups (1.8% vs 1.3%). Older age (HR, 1.64; 95% CI, 1.5-1.7; P<0.001), disease severity (HR, 2.24; 95% CI, 1.6-3.1 for severe AA; HR, 3.8; 95% CI, 2.4-6 for very severe AA), and male sex (HR, 1.45; 95% CI, 1.1-1.8; P<0.001) were significantly associated with mortality.