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International Journal of Hematology

, Volume 91, Issue 5, pp 770–775 | Cite as

Clinical course of non-severe aplastic anemia in adults

  • Ji Hyun Kwon
  • Inho KimEmail author
  • Yun Gyoo Lee
  • Youngil Koh
  • Hayne Cho Park
  • Eun Young Song
  • Hyun Kyung Kim
  • Sung Soo Yoon
  • Dong Soon Lee
  • Sung Sup Park
  • Hee Young Shin
  • Seonyang Park
  • Myoung Hee Park
  • Hyo Seop Ahn
  • Byoung-Kook Kim
Original Article

Abstract

The clinical course of non-severe aplastic anemia is variable, and risk factors related to disease progression are not well known. We reviewed clinical and laboratory data of the patients who were diagnosed with non-severe aplastic anemia from 1997 to 2007 at Seoul National University Hospital and analyzed the clinical course and outcomes in these patients. We defined non-severe aplastic anemia as hypocellular marrow with cytopenia in the peripheral blood, which does not meet the criteria for severe aplastic anemia (at least two of the following: ANC < 500/μl, platelet < 20,000/μl or reticulocyte < 20,000/μl). Among a total of 96 patients, 53 (55.2%) were male and the median age was 37.6 years old. As much as 41.7% (40) of the patients were initially asymptomatic. Sixty-two patients who were treated with oxymetholone, ATG/ALG, cyclosporin or other agents after initial diagnosis showed significantly lower levels of initial hemoglobin, red blood cell count and platelet count than those who did not receive any treatment. During the follow-up period, 18 patients progressed to severe aplastic anemia. Their median age was 29.9 years and the median progression time was 18 months. Initial white blood cell count and absolute neutrophil count in the evolution group tended to be lower than in the other group. The patients whose thrombocytopenia did not respond to treatment showed markedly higher frequency of progression to severe aplastic anemia. Treatment itself and responsiveness in reticulocyte and absolute neutrophil count were not correlated with their clinical courses. Sixteen patients showed overall improvement, whereas three patients developed secondary hematologic disease, acute myeloid leukemia, myelodysplastic syndrome and paroxysmal nocturnal hemoglobinuria. Non-severe aplastic anemia has a relatively indolent and mild clinical course. However, 18.8% of the study population progressed to severe disease. White blood cell and absolute neutrophil count at diagnosis and treatment responsiveness of thrombocytopenia were associated with disease progression. Careful monitoring and early management are needed for patients at risk.

Keywords

Non-severe aplastic anemia Clinical course Prognosis Treatment responsiveness 

Notes

Acknowledgments

This study was supported by grant No. 03-2009-0280 from the Seoul National University Hospital Research Fund and by a grant of the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (0405-BC02-0604-0004).

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Copyright information

© The Japanese Society of Hematology 2010

Authors and Affiliations

  • Ji Hyun Kwon
    • 1
  • Inho Kim
    • 1
    • 4
    • 5
    Email author
  • Yun Gyoo Lee
    • 1
  • Youngil Koh
    • 1
  • Hayne Cho Park
    • 1
  • Eun Young Song
    • 2
  • Hyun Kyung Kim
    • 2
  • Sung Soo Yoon
    • 1
    • 5
  • Dong Soon Lee
    • 2
  • Sung Sup Park
    • 2
  • Hee Young Shin
    • 3
  • Seonyang Park
    • 1
    • 4
    • 5
  • Myoung Hee Park
    • 2
  • Hyo Seop Ahn
    • 3
  • Byoung-Kook Kim
    • 1
    • 5
  1. 1.Department of Internal MedicineSeoul National University Hospital, College of MedicineSeoulRepublic of Korea
  2. 2.Department of Laboratory MedicineSeoul National University, College of MedicineSeoulKorea
  3. 3.Department of PediatricsSeoul National University, College of MedicineSeoulKorea
  4. 4.Diagnostic DNA chip CenterSeoul National University, College of MedicineSeoulKorea
  5. 5.Cancer Research InstituteSeoul National University College of MedicineSeoulRepublic of Korea

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