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Telomere Length Linked to Outcomes in Aplastic Anemia

Short telomere length associated with higher chance of relapse, clonal evolution, shorter survival

TUESDAY, Sept. 21 (HealthDay News) -- In patients with severe aplastic anemia receiving immunosuppressive therapy, telomere length is related to risk of relapse, clonal evolution, and survival, according to research published in the Sept. 22/29 issue of the Journal of the American Medical Association.

Phillip Scheinberg, M.D., of the National Institutes of Health (NIH) in Bethesda, Md., and colleagues analyzed data from 183 patients with severe aplastic anemia who were enrolled in three protocols at the NIH and were treated with antithymocyte globulin plus cyclosporine.

The researchers found that pretreatment leukocyte telomere length was not associated with hematologic response rates, which were 56.5 percent in the first and fourth quartiles. Telomere length, as a continuous variable, was inversely correlated with probability of hematologic relapse (hazard ratio, 0.16). Patients in the first quartile -- the shortest length -- had a higher probability of clonal evolution than those in the other quartiles (24.5 versus 8.4 percent). The first quartile also had a lower chance of surviving six years compared to the other patients (66 versus 83.8 percent).

"Clonal evolution to myelodysplasia is a major adverse event in severe aplastic anemia; it cannot be routinely predicted and usually signals a poor prognosis. In particular, the finding of monosomy 7 on bone marrow cytogenetics is associated with persistent pancytopenia unresponsive to immunosuppression and progression to myelodysplasia. The current work shows that telomere length relates to the development of abnormal marrow clones, in particular monosomy 7, with serious clinical consequences," the authors write.

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