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J Hematol Oncol. 2017 Jan 21;10(1):25. doi: 10.1186/s13045-017-0398-y.

Upfront haploidentical transplant for acquired severe aplastic anemia: registry-based comparison with matched related transplant.

Author information

1
Peking University Institute of Hematology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China.
2
The First Affiliated Hospital of Soochow University, Soochow, China.
3
Guangzhou First People's Hospital, Guangzhou, China.
4
Xiehe Hospital affiliated to Huazhong University of Science and Technology, Wuhan, China.
5
Lanzhou Military Area General Hospital, Lanzhou, China.
6
The First Hospital of Jilin University, Changchun, China.
7
Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, China.
8
Changhai Hospital affiliated to Second Military Medical University, Shanghai, China.
9
Shandong Provincial Hospital, Jinan, China.
10
The First Affiliated Hospital of Xinjiang Medical University, Urumchi, China.
11
Xinqiao Hospital Affiliated to Third Military Medical University, Chongqing, China.
12
Peking University Institute of Hematology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, People's Republic of China. huangxiaojun@bjmu.edu.cn.
13
Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China. huangxiaojun@bjmu.edu.cn.
14
Peking-Tsinghua Center for Life Sciences, Beijing, China. huangxiaojun@bjmu.edu.cn.

Abstract

BACKGROUND:

Haploidentical donor (HID) hematopoietic stem cell transplantation (HSCT) is an alternative treatment method for severe aplastic anemia (SAA) patients lacking suitable identical donors and those who are refractory to immunosuppressive therapy (IST). The current study evaluated the feasibility of upfront haploidentical HSCT in SAA patients.

METHODS:

We conducted a multicenter study based on a registry database. One hundred fifty-eight SAA patients who underwent upfront transplantation between June 2012 and September 2015 were enrolled.

RESULTS:

Eighty-nine patients had haploidentical donors (HIDs), and 69 had matched related donors (MRDs) for HSCT. The median times for myeloid engraftment in the HID and MRD cohorts were 12 (range, 9-20) and 11 (range, 8-19) days, with a cumulative incidence of 97.8 and 97.1% (P = 0.528), respectively. HID recipients had an increased cumulative incidence of grades II-IV acute graft-versus-host disease (aGVHD) (30.3 vs. 1.5%, P < 0.001), grades III-IV aGVHD (10.1 vs. 1.5%, P = 0.026), and chronic GVHD (cGVHD) (30.6 vs. 4.4%, P < 0.001) at 1 year but similar extensive cGVHD (3.4 vs. 0%, P = 0.426). The three-year estimated overall survival (OS) rates were 86.1 and 91.3% (P = 0.358), while the three-year estimated failure-free survival (FFS) rates were 85.0 and 89.8% (P = 0.413) in the HID and MRD cohorts, respectively. In multivariate analysis, survival outcome for the entire population was significantly adversely associated with increased transfusions and poor performance status pre-SCT. We did not observe differences in primary engraftment and survival outcomes by donor type.

CONCLUSIONS:

Haploidentical SCT as upfront therapy was an effective and safe option for SAA patients, with favorable outcomes in experienced centers.

KEYWORDS:

Acquired severe aplastic anemia; Haploidentical transplantation; Upfront

PMID:
28107815
PMCID:
PMC5251320
DOI:
10.1186/s13045-017-0398-y
[Indexed for MEDLINE]
Free PMC Article

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