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Background <p>Acquired aplastic anemia (AAA) is an immune mediated bone marrow failure syndrome in which misdirected T cells injure hematopoietic stem and progenitor cells, leading to pancytopenia. Patterns of lymphocyte subsets may carry prognostic value and could help individualize treatment strategies.</p> Objectives <p>To assess peripheral blood lymphocyte subset clusters in AAA and to identify the association with baseline disease severity and treatment response.</p> Methods <p>This was a prospective cohort study including 47 adults conducted at a tertiary care centre. Lymphocyte subsets (CD4⁺ and CD8⁺ T cells, CD19⁺ B cells, and CD56⁺ natural killer cells) were quantified by flow cytometry, and patients were categorized according to the predominant subsets with a six-month follow up.</p> Results <p>There were 24 male and 23 female patients with a mean age of 47 ± 12.2 years. CD4-predominant and CD8-predominant clusters were seen in 37 (78.7%) and 10 (21.3%) respectively. Patients in the CD8-predominant vs. CD4-predominant cluster had higher baseline platelet counts (25,000 vs. 8,000/µL, <i>p</i> = 0.054), better treatment response (partial response in 87.5% vs. 39.4%, <i>p</i> = 0.039) and survival (90% vs. 51.4%, <i>p</i> = 0.034). Among patients treated with antithymocyte globulin, all CD8-predominant cluster patients achieved partial response, with significant gains in hemoglobin (<i>p</i> = 0.028), platelet count (<i>p</i> = 0.018), and absolute neutrophil count (<i>p</i> = 0.050). Absolute counts of CD4, CD8, and B cells declined with increasing disease severity (<i>p</i> &lt; 0.05), whereas natural killer cell counts did not vary significantly.</p> Conclusion <p>In AAA, lymphocyte subset clusters, particularly CD8-predominance, identifies a prognostically favourable subgroup with higher baseline platelet counts, better treatment response, and improved survival.</p>

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Assessment of Lymphocyte Subset Clusters in Acquired Aplastic Anemia: A Prospective Cohort Study

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Powmitha Gopi,
  • Deepak Amalnath,
  • Prabhu Manivannan,
  • Rakhee Kar

摘要

Background

Acquired aplastic anemia (AAA) is an immune mediated bone marrow failure syndrome in which misdirected T cells injure hematopoietic stem and progenitor cells, leading to pancytopenia. Patterns of lymphocyte subsets may carry prognostic value and could help individualize treatment strategies.

Objectives

To assess peripheral blood lymphocyte subset clusters in AAA and to identify the association with baseline disease severity and treatment response.

Methods

This was a prospective cohort study including 47 adults conducted at a tertiary care centre. Lymphocyte subsets (CD4⁺ and CD8⁺ T cells, CD19⁺ B cells, and CD56⁺ natural killer cells) were quantified by flow cytometry, and patients were categorized according to the predominant subsets with a six-month follow up.

Results

There were 24 male and 23 female patients with a mean age of 47 ± 12.2 years. CD4-predominant and CD8-predominant clusters were seen in 37 (78.7%) and 10 (21.3%) respectively. Patients in the CD8-predominant vs. CD4-predominant cluster had higher baseline platelet counts (25,000 vs. 8,000/µL, p = 0.054), better treatment response (partial response in 87.5% vs. 39.4%, p = 0.039) and survival (90% vs. 51.4%, p = 0.034). Among patients treated with antithymocyte globulin, all CD8-predominant cluster patients achieved partial response, with significant gains in hemoglobin (p = 0.028), platelet count (p = 0.018), and absolute neutrophil count (p = 0.050). Absolute counts of CD4, CD8, and B cells declined with increasing disease severity (p < 0.05), whereas natural killer cell counts did not vary significantly.

Conclusion

In AAA, lymphocyte subset clusters, particularly CD8-predominance, identifies a prognostically favourable subgroup with higher baseline platelet counts, better treatment response, and improved survival.