Apolipoprotein-A is a potential prognostic biomarker for severe aplastic anemia patients treated with ATG-based immunosuppressive therapy: a single-center retrospective study

Lipids Health Dis. 2022 Oct 4;21(1):93. doi: 10.1186/s12944-022-01703-0.

Abstract

Background: Anti-thymoglobulin (ATG)-based immunosuppressive treatment (IST) is the standard first-line management for patients with severe AA/very severe AA (SAA/VSAA) and is not suitable for allogeneic stem cell transplantation. The response predictor was not fully investigated.

Objective: The present study attempted to explore other characteristics, such as serum lipid changes, during ATG-based IST and analyzed their significance in predicting IST response and survival.

Methods: A total of 61 newly diagnosed SAA/VSAA patients who received ATG-based IST were enrolled from January 2011 to June 2019. The blood lipid levels, immunoglobulins, and peripheral T lymphocytes were retrospectively collected, and their correlations with IST response, estimated 8.5-year overall survival (OS) and event-free survival (EFS) were analyzed.

Results: The overall response (OR)/complete remission (CR) at 3, 6, and 9 months was 24.6%/6.6%, 52.5%/14.8%, and 65.6%/23.0%, respectively. Based on the 9-month response effect, patients were divided into IST-response (IST-R) and IST-nonresponse (IST-NR) groups. The subgroup baseline characteristics showed that the disease severity grade, absolute neutrophil granulocyte count (ANC), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and apolipoprotein-A (Apo-A) differed between the IST-R and IST-NR groups. Patients with lower Apo-A (< 1.205 g/L) level pretreatment had a better event-free survival (EFS), and a moderate negative correlation was established between the pretreatment Apo-A and 9-month response (P = 0.004). In addition, the T-cell subset and immunoglobulin analyses showed that the responsive patients had a low serum IgA level, which decreased further after therapy. Additionally, a moderate negative correlation was established between the 3-month IgA and 9-month response (P = 0.006).

Conclusion: Serum Apo-A is a prognostic biomarker for newly diagnosed < 60-year-old SAA/VSAA patients who received ATG-based IST (registered at chictr.org.cn as # ChiCTR2100052979).

Keywords: Aplastic anemia; Apolipoprotein-A; Blood lipid; Immune globulin; T-cell subset.

MeSH terms

  • Anemia, Aplastic* / drug therapy
  • Apolipoproteins
  • Apolipoproteins A
  • Biomarkers
  • Cholesterol, LDL
  • Cyclosporine
  • Humans
  • Immunoglobulin A
  • Immunosuppression Therapy
  • Immunosuppressive Agents / therapeutic use
  • Lipoproteins, HDL
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Apolipoproteins
  • Apolipoproteins A
  • Biomarkers
  • Cholesterol, LDL
  • Immunoglobulin A
  • Immunosuppressive Agents
  • Lipoproteins, HDL
  • Cyclosporine