Addition of eltrombopag to immunosuppressive therapy (ATG, cyclosporine) in acquired aplastic anemia: A tertiary care center experience

Aims & Objectives: To assess the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag in addition to Immunosuppressive therapy (ATG → Cyclosporine A) at our tertiary care center Patients/Materials & Methods: We retrospectively analysed the responses of Acquired Aplastic Anaemia patients who have received Eltrombopag, Antithymocyte globulin, and Cyclosporine A from Jan 2019 to March 2020 Results: Thirty-eight patients were included in our study The median age is 27 6 years (7-68) Male to Female ratio 1 2:1 6 patients were less than 13 years of age and, 31 patients were between>13 years to60 years PNH clone was positive in 6 patients(15%) Majority of our patients were Severe Aplastic Anemia (76 3%), and Non Severe Aplastic Anemia (10 5%), Very Severe Aplastic Anaemia(13 1%) All of our patients received Cyclosporine and Danazol before ATG The median duration from diagnosis to treatment is 12 2 months(1-60 months) Except for one who received Rabbit ATG, everyone received Equine ATG Eltrombopag was given at a dose of 75 mg in 13 15% (5) and 150 mg in 86 85% (33) Complete Response, Partial Response, No response were seen in 15 8%,57 8%,26 5% respectively 3 patients expired within three months of treatment, 3 more patients expired by 6 months(1, COVID-19) Discussion & Conclusion: Overall Response rates of 75% in an Indian cohort of acquired aplastic anemia patients treated with ATG and Cyclosporine plus Eltrombopag is comparable to that reported in studies from US and Europe Median duration of disease prior to ATG based IST was 1 year in our cohort of AA patients Addition of eltrombopag to ATG and Cyclosporine was able to overcome the delayed initiation of IST in AA patients Treatment was well tolerated in our patients