Objective To evaluate the efficacy and safety of roxadustat in patients with refractory non-severe aplastic anemia(NSAA).Methods The clinical data of patients with refractory NSAA who had been treated with roxadustat continuously for at least 3 months and followed up for more than 6 months at Peking Union Medical College Hospital from October 2020 to August 2022 were retrospectively collected.The demographic information,clinical data,treatment efficacy,adverse reactions,and outcomes were evaluated,and the factors influencing efficacy were analyzed.Results A total of 41 patients were included.The male-to-female ratio was 16∶25,and the median age was 52(18-84)years.The median duration of roxadustat treatment was 5(3-20)months,and the median follow-up was 15(6-26)months.Hematologic improvement-erythroid(HI-E)was 12.2%,29.3%,46.3%,43.9%,and 30.3%at 1,2,3,6,and 12 months,respectively.The rate of transfusion independence was 28.5%,38.1%,and 33.3%at 3,6,and 12 months,respectively.Hemoglobin returned to normal in some patients after treatment with roxadustat.The incidence of adverse events was 22%,all of which were grade Ⅰ-Ⅱ and recoverable.No factors that could affect HI-E were identified.By the end of follow-up,45%of the patients relapsed,with a median time to relapse of 7(3-12)months.No clonal evolution was observed,and one patient died.Conclusion Roxadustat effectively improved anemia with good tolerance in patients with refractory NSAA.