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

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/µL, 12,000/µL, and 0.39%, respectively. In multivariate analyses, ANC <500/µL or ≥500/µL ( 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.

Childhood aplastic anaemia with paroxysmal nocturnal haemoglobinuria clones: A retrospective single-centre study in South Africa

“…A study in Korea highlighted that the ANC should be more heavily weighted, as it has the biggest impact on patient complications, is not influenced by transfusions, and can be readily used to classify severity in patients. 35 In our cohort, 15 of the 18 patients had a neutrophil count of < 0.5 × 10 9/ L, while the haemoglobin and platelet counts remained above the defined cut-off likely due to transfusions received, suggesting that ANC may be a more important factor to consider in the diagnosis and severity grading of patients with AA.…”

Importance of the Third Trimester Complete Blood Count: A Case Report on Aplastic Anemia in Pregnancy

“…Patients with absolute neutrophil count of < 0.2 × 10 9 /L meet criteria for very severe. As in our case, patients with hypocellular bone marrow not meeting criteria for severe or very severe are considered nonsevere [ 6 ].…”

Fungal arthritis of the hip in patient with aplastic anaemia

“…Medullar bone biopsy showed medullar hypoplasia. A diagnosis of aplastic anaemia was established; according to Camitta's criteria, the patient had severe aplastic anaemia 1. Before administration of the immunosupressors, he developed a high fever that was treated with piperacilline-tazobactam and levofloxacin.…”