Aplastic anaemia with underlying hepatitis leads to worse survival in kids

Aplastic anaemia in children appears to lead to worse outcomes when associated with hepatitis, a recent Taiwan study has found. Vaccination against the hepatitis B virus (HBV) may have additional value in this population.

Seventy-eight paediatric patients (median age, 8.4 years; 55 percent male) with aplastic anaemia participated in the present study, including nine who had hepatitis-associated disease. Treatment response was determined according to the number of peripheral blood neutrophils and was assessed at 3 and 6 months after treatment initiation; survival was also considered as a study endpoint.

The estimated 10-year overall survival rate in the study sample was 72.7 percent, while the haematopoietic stem cell transplantation-free survival rate over the same time scale was 45.2 percent.

Grouping according to hepatitis, patients with hepatitis-associated disease had significantly worse 10-year overall survival outlook (44.4 percent vs 76.1 percent; p=0.0042). Multivariate Cox regression analysis showed that this association with hepatitis was a significant predictor of poor survival (hazard ratio, 3.57, 95 percent confidence interval, 1.22–10.44; p=0.02).

On the other hand, anaemia severity seemed to only nominally worsen severity but failed to achieve a statistically significant effect. Similarly, haematologic response 3 and 6 months after treatment initiation was comparable between patient groups.

“A nationwide hepatitis B vaccination program could decrease the incidence of childhood hepatitis B-associated aplastic anaemia in HBV-endemic areas,” the researchers said.