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This study aimed to explore the incidence and outcomes of patients with adult AA across the country of Thailand. This is a prospective multi-center nationwide population-based observational study of AA patients aged at least 15\u00a0years old, diagnosed from August 2014 to July 2016, with a longitudinal follow-up period over 2\u00a0years. There were 348 newly diagnosed adult AA patients during the enrollment period, giving an annual incidence of 4.6 per million. The incidence of severe (SAA) and very severe aplastic anemia (VSAA) (3.8 per million) was higher than non-severe AA (NSAA, 0.8 per million). The peak incidence was observed in the patients aged from 80 to 89\u00a0years old (14.4 per million). The 2-year overall survival (OS) in NSAA, SAA, and VSAA were 65.5%, 49.3%, and 20.1%, respectively (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). With regard to the response to immunosuppressive therapy, the overall response rate (ORR) in SAA\/VSAA treated with rabbit anti-thymocyte globulin with\/without cyclosporin A (rATG\u2009\u00b1\u2009CsA) were significantly superior to those treated with CsA alone, or anabolic steroids (44.4% vs 36.4% and 31.2%, respectively, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). The 2-year OS in SAA\/VSAA treated with rATG\u2009\u00b1\u2009CsA, CsA, and anabolic steroids were 54.8%, 54.5%, and 37.6% (<jats:italic>P<\/jats:italic>\u2009=\u20090.037), respectively. The incidence of adult AA in Thailand is higher than those in Western countries, and the peak incidence is in the elderly. rATG\u2009\u00b1\u2009CsA provided a better response than anabolic steroids, translating to the superior survival in SAA\/VSAA treated with rATG\u2009\u00b1\u2009CsA.<\/jats:p>","DOI":"10.1007\/s00277-021-04566-0","type":"journal-article","created":{"date-parts":[[2021,7,16]],"date-time":"2021-07-16T04:02:41Z","timestamp":1626408161000},"page":"2443-2452","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Adult aplastic anemia in Thailand: incidence and treatment outcome from a prospective nationwide population-based study"],"prefix":"10.1007","volume":"100","author":[{"given":"Lalita","family":"Norasetthada","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somchai","family":"Wongkhantee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jindaratn","family":"Chaipokam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanyaporn","family":"Charoenprasert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suporn","family":"Chuncharunee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ponlapat","family":"Rojnuckarin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chittima","family":"Sirijerachai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanchai","family":"Wanachiwanawin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8924-0646","authenticated-orcid":false,"given":"Surapol","family":"Issaragrisil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Thai Aplastic Anemia Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,16]]},"reference":[{"issue":"9","key":"4566_CR1","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.3324\/haematol.2008.002642","volume":"94","author":"E Maluf","year":"2009","unstructured":"Maluf E, Hamerschlak N, Cavalcanti AB, Junior AA, Eluf-Neto J, Falcao RP, Lorand-Metze IG, Goldenberg D, Santana CL, Rodrigues Dde O, Passos LN, Rosenfeld LG, Pitta M, Loggetto S, Ribeiro AA, Velloso ED, Kondo AT, Coelho EO, Pintao MC, de Souza HM, Borbolla JR, Pasquini R (2009) Incidence and risk factors of aplastic anemia in Latin American countries: the LATIN case-control study. 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