Comparable long-term outcomes between upfront haploidentical and identical sibling donor transplant in aplastic anemia: a national registry-based study
Zheng-Li Xu,
Lan-Ping Xu,
De-Pei Wu,
Shun-Qing Wang,
Xi Zhang,
Rui Xi,
Su-Jun Gao,
Ling-Hui Xia,
Jian-Min Yang,
Ming Jiang,
Xin Wang,
Qi-Fa Liu,
Jia Chen,
Ming Zhou,
Xiao-Jun Huang
Affiliations
Zheng-Li Xu
Peking University People’s Hospital, Peking University Institute of Hematology, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
Lan-Ping Xu
Peking University People’s Hospital, Peking University Institute of Hematology, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China
De-Pei Wu
The First affiliated Hospital of Soochow University, Soochow, China
Shun-Qing Wang
Guangzhou First People’s Hospital, Guangzhou, China
Xi Zhang
Xinqiao Hospital affiliated to Third Military Medical University, Chongqing, China
Rui Xi
General Hospital of Lanzhou Military Region of PLA, Lanzhou, China
Su-Jun Gao
The First Hospital of Jilin University, Changchun, China
Ling-Hui Xia
Xiehe Hospital affiliated to Huazhong University of Science and Technology, Wuhan, China
Jian-Min Yang
Changhai Hospital affiliated to Second Military Medical University, Shanghai, China
Ming Jiang
The First affiliated Hospital of Xinjiang Medical University, Urumchi, China
Xin Wang
Shandong Provincial Hospital, Jinan, China
Qi-Fa Liu
Nanfang Hospital affiliated to Southern Medical University, Guangzhou, China
Jia Chen
The First affiliated Hospital of Soochow University, Soochow, China
Ming Zhou
Guangzhou First People’s Hospital, Guangzhou, China
Xiao-Jun Huang
Peking University People’s Hospital, Peking University Institute of Hematology, Beijing, China; National Clinical Research Center for Hematologic Disease, Beijing, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Peking-Tsinghua Center for Life Sciences, Beijing, China
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a curative option for severe aplastic anemia (SAA), and transplantation from identical sibling donors (ISD) has been recommended as a first-line treatment. Haploidentical donor (HID) transplantation for SAA has made great advances; thus, an increased role of HID-SCT in SAA should be considered. We performed a national registry-based analysis comparing long-term outcomes in the upfront HID or upfront ISD SCT setting. A total of 342 SAA patients were enrolled, with 183 patients receiving HID SCT and 159 receiving ISD SCT. The estimated 9-year overall survival and failure-free survival were 87.1±2.5% and 89.3±3.7% (P=0.173) and 86.5±2.6% versus 88.1±3.8% (P=0.257) for patients in the HID and ISD SCT groups, respectively. Transplantation from HID or ISD SCT has greatly improved quality of life (QoL) levels post-HSCT compared to pre-HSCT. The occurrence of chronic graft-versus-host disease was the only identified adverse factor affecting each subscale of QoL. Physical and mental component summaries in adults as well as physical, mental, social, and role well-being in children were all similar between HID and ISD SCT at 5-year time points. At the last follow-up, the proportion of returning to society was comparable between the HID and ISD groups, showing 78.0% versus 84.6% among children and 74.6% versus 81.2% among adults. These data suggest that haploidentical transplant can be considered a potential therapeutic option in the upfront setting for SAA patients in the absence of an HLA-identical related or unrelated donor.
