Abstract
OBJECTIVE: To explore the effects of peri-immunosuppressive treatment（IST）infection on outcomes of severe and very severe aplastic anemia（SAA/VSAA）patients. METHODS: Medical record and follow-up data of 105 SAA/VSAA who underwent first-line IST were retrospectively analyzed to find out the characters of infections（1 month before to 3 months after IST）, and its effects on hematologic response and survival. RESULTS: Of 105 patients, a total of 270 febrile episodes were recorded in 97 patients（92.4%）during their peri- IST periods, with the median infections of 2（1-7）episodes in each patient with the median febrile duration of 7（1-47）days. Respiratory system（35.1%）was the primary anatomic site of infection. Bacteria（88.2%）were common causes of total 169 pathogenic bacteria in 96 clear pathogenic bacteria episodes. And patients who got infection 1 month before IST had much lower 6- month hematologic response rate than their counterpart ones（50.8% vs 80.0%, P=0.004）. Multiple febrile episodes （ ≥3 times） and the total febrile duration ≥4 days showed the best sensitivity and specificity according to the ROC curve analysis. The 5-year overall survival of the 105 patients was 76%. The 5- year OS of patients with multiple febrile episodes （ ≥3 times） were much lower than their counterpart ones［（59.6±7.2）% vs（89.5±4.0）%］（P＜0.01）. The 5-year OS of the total febrile duration ≥4 days was much lower than their counterpart ones［（63.4±5.8）% vs 100.0%］（P＜0.01）. CONCLUSION: Infections 1 month before IST were associated with hematologic response. Multiple febrile episodes（≥3 times） and infections with the febrile duration ≥4 days presented inferior hematologic response and survival.