{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T09:37:01Z","timestamp":1792143421191,"version":"4.4.0"},"reference-count":13,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    We retrospectively analyzed a large international cohort of 1113 patients with aplastic anemia to evaluate treatment choice and outcome in elderly patients as compared with a younger population. Overall, 319 (29%) patients were\u2009&gt;\u200960\u2009years old at diagnosis (60\u201364\u2009years (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200985), 106 65\u201369\u2009years (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009106), and 128\u2009&gt;\u200970\u2009years (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009128)). Elderly patients showed a more severe thrombocytopenia at onset and a significantly lower overall response (complete plus partial) to first\u2010line therapy at 6\u2009months as compared to younger patients (47% vs. 65%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.0001), irrespective of treatment modality (ATG or CyA combinations, eltrombopag, or androgens); 27 (8%) received transplant as second line therapy and 11 (41%) died, mainly due to transplant complications. The rate of evolution to MDS was greater in elderly patients (12% vs. 7% in younger AA,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002), whilst the rate of evolution to AML was similar (1.8 vs. 1.3%). By multivariable analysis, older age remained the main factor associated with mortality [HR 1.64 (95% CI 1.5\u20131.7),\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001], followed by disease severity by Camitta classification [HR 2.24 (95% CI 1.6\u20133.1) for severe AA; HR 3.8 (95% CI 2.4\u20136) for very severe AA], and male gender [1.45 (95% CI 1.1\u20131.8),\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001]. In this large study, elderly AA was associated with inferior outcome even in the TPO\u2010RA era, highlighting the need for further optimization of clinical management.\n                  <\/jats:p>","DOI":"10.1002\/ajh.27611","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T05:26:18Z","timestamp":1738128378000},"page":"584-591","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Elderly Patients With Aplastic Anemia: Treatment Patterns and Outcomes in the Real World"],"prefix":"10.1002","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-8379","authenticated-orcid":false,"given":"Bruno","family":"Fattizzo","sequence":"first","affiliation":[{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan  Milan Italy"},{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6829-5544","authenticated-orcid":false,"given":"Carmelo","family":"Gurnari","sequence":"additional","affiliation":[{"name":"Department of Translational Hematology and Oncology Research Taussig Cancer Institute, Cleveland Clinic  Cleveland Ohio USA"},{"name":"Department of Biomedicine and Prevention University of Rome Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Giammarco","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli\u2010Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antony","family":"Ricchiuti","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan  Milan Italy"},{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1445-7947","authenticated-orcid":false,"given":"Hussein","family":"Awada","sequence":"additional","affiliation":[{"name":"Department of Translational Hematology and Oncology Research Taussig Cancer Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5147-970X","authenticated-orcid":false,"given":"Marta","family":"Bortolotti","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan  Milan Italy"},{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6776-8647","authenticated-orcid":false,"given":"Nicole","family":"Galli","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan  Milan Italy"},{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7727-2766","authenticated-orcid":false,"given":"Giacinto Luca","family":"Pedone","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan  Milan Italy"},{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Versino","sequence":"additional","affiliation":[{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan  Milan Italy"},{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Consonni","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roochi","family":"Trikha","sequence":"additional","affiliation":[{"name":"Hematology Unit, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreyans","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Hematology Unit, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Sica","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli\u2010Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaroslaw P.","family":"Maciejewski","sequence":"additional","affiliation":[{"name":"Department of Translational Hematology and Oncology Research Taussig Cancer Institute, Cleveland Clinic  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3180-3570","authenticated-orcid":false,"given":"Austin","family":"Kulasekararaj","sequence":"additional","affiliation":[{"name":"Hematology Unit, King's College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1428-9944","authenticated-orcid":false,"given":"Wilma","family":"Barcellini","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.19236"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2109965"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352\u20103026(23)00395\u20102"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.19648"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102016\u201008\u2010693481"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375\u2010019\u20100457\u20101"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022015850"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375\u2010022\u201001613\u20101"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.blre.2023.101132"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41375\u2010023\u201002047\u2010z"},{"key":"e_1_2_10_12_1","unstructured":"Sirolimus (Rapamune) for Relapse Prevention in People With Severe Aplastic Anemia Responsive to Immunosuppressive Therapy NCT02979873 accessed on October 15 2024 https:\/\/clinicaltrials.gov\/study\/NCT02979873."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2023010959"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102023\u2010076246"}],"container-title":["American Journal of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ajh.27611","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T05:06:15Z","timestamp":1752901575000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ajh.27611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,29]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1002\/ajh.27611"],"URL":"https:\/\/doi.org\/10.1002\/ajh.27611","archive":["Portico"],"relation":{},"ISSN":["0361-8609","1096-8652"],"issn-type":[{"value":"0361-8609","type":"print"},{"value":"1096-8652","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,29]]},"assertion":[{"value":"2025-01-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}