Korean J Hematol.  2012 Jun;47(2):126-130. 10.5045/kjh.2012.47.2.126.

Should we still use Camitta's criteria for severe aplastic anemia?

• Yoon HH
• Huh SJ
• Lee JH
• Lee S
• Kim SH
• Kwon HC
• Kim HJ

• KMID: 2083606
• DOI: http://doi.org/10.5045/kjh.2012.47.2.126

Abstract

BACKGROUND
The criteria by Camitta for diagnosis in severe aplastic anemia (SAA) has been used since 1976. However, there has been no attempt to verify the Camitta's criteria, that the survival in patients with SAA may differ by absolute neutrophil count (ANC), platelet count (PLT), and corrected reticulocyte count (CRC), which are components of the Camitta's criteria.
METHODS
117 SAA patients diagnosed by the Camitta's criteria were analyzed, retrospectively. Univariate and multivariate analyses were used to evaluate the factors affecting overall survival (OS).
RESULTS
Response by immunosuppressive therapy (IST) or stem cell transplantation (SCT) significantly affected OS (P=0.001). Therefore, we excluded treatment responders for analysis. Finally, 92 SAA patients including treatment non-responders by IST or SCT and conservative care group were analyzed by using univariate and multivariate analyses. The median age of analyzed patients was 54.5 years. Male to female ratio was 1:1. The median follow-up duration was 74.23 months (range, 54.71-93.74 months). The median ANC, PLT, and CRC were 394/microL, 12,000/microL, and 0.39%, respectively. In multivariate analyses, ANC <500/microL or > or =500/microL (P=0.015, HR 2.694, 95% CI: 1.20-6.01) and age (P=0.015, HR 1.022, 95% CI: 1.00-1.04) were the significant factors for OS.
CONCLUSION
ANC could be an essential, not an optional criterion for diagnosing SAA. This study suggests the possibility that the Camitta's criteria be modified. Studies in large cohorts are needed to transform the Camitta's criteria.

Keyword

Camitta's criteria; Severe aplastic anemia; Absolute neutrophil count

MeSH Terms

Anemia, Aplastic
Cohort Studies
Female
Follow-Up Studies
Humans
Male
Multivariate Analysis
Neutrophils
Platelet Count
Reticulocyte Count
Retrospective Studies
Stem Cell Transplantation

Figure

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  Fig. 1 Diagram of patients included in this study. Abbreviations: SAA, severe aplastic anemia; IST, immunosuppressive therapy; SCT, stem cell transplantation.

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  Fig. 2 Survival curves according to the treatment response. The median survival was 195 months in the treatment responder group vs. not yet reached in the treatment non-responder and conservative care group (P=0.0014).

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  Fig. 3 Survival curves according to absolute neutrophil count (ANC). The median survival was 195 months in ANC <500/µL vs. not yet reached in ANC ≥500/µL (P=0.014). Abbreviation: ANC, absolute neutrophil count.

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