Risk factors related to poor prognosis in refractory severe aplastic anemia cases after integrated immuno-suppressive therapy.

Objective To investigate the risk factors related to poor prognosis in refractory severe aplastic anemia (SAA) patients after immunosuppressive therapy.Methods Multivariate analysis was used to analyze the correlation of post-IST refractoriness and patient survival with sex,age,etiology,delay between diagnosis and IST,severity of SAA (onset absolute neutrophil count),infection at onset,ATG regime,G-CSF therapy and PNH clone in 154 SAA patients treated in Institute of Hematology Blood Diseases Hospital of Chinese Academy of Medical Science during Dec 1996 to Oct 2006.Results The severity of SAA and infection were risk factors for refractory disease and poor survival.According to multivariate analysis,disease severity and infection were risk factors of IST refractoriness and poor prognosis.Risk of monomer-7 included clonal chromosome evoluting to MDS increased with use of G-CSF for more than 6 months.Conclusion The severity of SAA and occurrence of infection were the major risk factors for refractoriness and poor prognosis of IST,while use of G-CSF for more than 6 months was a risk factor of MDS development.