The outlook for adults with aplastic anemia depends on many factors, like age and overall health, aplastic anemia severity, and treatment response. Aplastic anemia is life threatening when not treated.

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Aplastic anemia (AA) happens when the bone marrow doesn’t make enough healthy blood cells. This leads to low red blood cells (RBCs), white blood cells (WBCs), and platelets.

Without treatment, people with AA can experience potentially life threatening complications. Keep reading to learn about the outlook for adults with AA.

Generally speaking, the outlook for adults with AA depends on a few different factors. These include:

  • the severity of your AA
  • your age and overall health
  • the type of treatment you receive and the response to it

Due to advances in treatment, AA’s outlook has improved over the past 3 decades. New advances and insights into the treatment of AA continue to be made.

For example, a 2022 trial showed that adding eltrombopag, a drug that boosts platelet count, to standard immunosuppressive therapy for AA improved the rate, speed, and strength of the treatment response in previously untreated adults and adolescents with AA.

Below, we look at some research into AA outlook in adults.

Research into aplastic anemia outlook

A 2017 study including individuals with AA noted that overall survival declined with increasing age. Researchers found that 5-year overall survival was:

  • 90.5% for adults ages 19–39 years
  • 70.7% for adults ages 40–59 years
  • 38.1% for adults ages 60 years or older

A 2019 study retrospectively analyzed outcomes in 88 adults over age 60 with AA, most of whom received standard immunosuppressive therapy. Researchers found that 32% of participants had a complete response to treatment, while 15% had a partial response.

Researchers also identified several factors associated with a poorer outlook, including:

  • age
  • very severe AA
  • high levels of other underlying health conditions, called comorbidities

A 2020 study retrospectively assessed 302 people with AA. Survival at 30 years was similar between those who had a stem cell transplant and those who had immunosuppressive therapy. Survival improved in people treated more recently.

The study also noted that:

  • Partial or no response to treatment was more common after immunosuppressive therapy.
  • Relapse of AA occurred in 24% of people who had immunosuppressive therapy, while a complication called graft-versus-host disease happened in 19% of people who received a stem cell transplant.
  • Complications like iron overload, cardiovascular events, and progression to myelodysplastic syndrome or leukemia happened more often in people who received immunosuppressive therapy.

It’s possible for AA to worsen over time. However, the rate at which this occurs can vary by individual.

Another concern is that people with AA can also eventually develop other blood conditions. These include myelodysplastic syndrome and acute myeloid leukemia.

Researchers estimate about 15% of people with AA go on to develop myelodysplastic syndrome or acute myeloid leukemia within 10 years. This is more common in people receiving immunosuppressive therapy.

In people with AA, the stem cells in the bone marrow that typically form blood cells are damaged or destroyed. This leads to low levels of RBCs, WBCs, and platelets.

RBCs carry oxygen to your body’s tissues and carry away carbon dioxide, a waste gas. When RBC levels are low, it leads to anemia. Some general symptoms of anemia are:

WBCs are immune cells that work to protect your body from infections. When WBC levels get too low, the risk of infections increases.

Platelets are tiny blood cells important to blood clotting. If your platelet levels are too low, you can experience easy bruising or bleeding.

The treatment you receive for AA can depend on things like how severe your AA is as well as your age and overall health.

Sometimes, an underlying condition or a medication can cause AA. In these situations, your doctor works to address that. For example, they can treat the infection or stop the medication.

Immunosuppressive therapy can help stop your immune system from attacking stem cells in your bone marrow. Younger people with AA who are in good health may be eligible for a stem cell transplant. It uses stem cells from a healthy matched donor.

A 2018 study also notes that a stem cell transplant could also be considered in older individuals whose AA has not responded to immunosuppressive therapy and are in good overall health.

Other potential treatments for AA include:

It’s possible for AA to lead to potentially life threatening complications. These include:

You can also experience complications related to AA treatment. Some examples include:

  • a reaction to medications used to treat AA
  • graft-versus-host disease after a stem cell transplant
  • hemochromatosis, which is iron overload in the body from repeated transfusions

When to call a doctor

If you have AA, contact your doctor immediately or seek medical attention if you have:

If you have AA, there are certain things you can do in your daily life to help reduce your risk of complications. These include:

  • lowering your risk of infections, such as by:
    • avoiding individuals who are currently ill as well as large crowds
  • eating a well-balanced diet and avoiding foods that may cause foodborne illness, such as:
    • raw or undercooked foods
    • fruits and vegetables you cannot peel
    • unpasteurized dairy products or juices
  • doing gentle, low impact exercise while avoiding intense physical activity or contact sports, as it can lead to bleeding events
  • making sure to get enough rest, especially when you’re feeling very fatigued

How long can you survive with aplastic anemia?

A 2017 study notes a median survival time of 150 months (12.5 years) in people with AA. Most deaths occurred within the first 2 years of diagnosis and were related to AA complications, like infections or bleeding.

What are the odds of recovering from aplastic anemia?

The outlook for a person with AA varies by individual and can depend on several factors. However, in some cases, a stem cell transplant can restore healthy bone marrow and may cure AA.

Can children get aplastic anemia?

Yes. Acquired AA is estimated to affect about 2 out of every 1 million children in North America and Europe each year.

AA occurs when your bone marrow doesn’t make enough healthy blood cells. It can lead to serious and sometimes life threatening complications if it’s not treated.

The outlook for a person with AA depends on many factors, such as age and overall health, the severity of AA, and the response to treatment. Overall, AA outlook has been improving due to advances in treatment.

The treatment for AA can include a stem cell transplant or immunosuppressive therapy. Like outlook, treatment choices depend on your age, overall health, and AA severity. In some cases, a stem cell transplant cures AA.