Jichu yixue yu linchuang (Jun 2020)

Comparison of intensive immunosuppressive therapy with haploidentical transplantation for young severe aplastic anemia

  • CHEN Miao, WU Ya-mei, ZHOU Dao-bin, DUAN Ming-hui, ZHUANG Jun-ling, HAN Bing, WU Xiao-xiong

Journal volume & issue
Vol. 40, no. 6
pp. 759 – 764

Abstract

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Objective A retrospective study was performed to compare intensive immunosuppressive therapy (IST) and haploidentical donor hematopoietic stem cell transplantation (HID-HSCT) for young patients with severe aplastic anaemia(SAA). Methods Fifty-five SAA patients aged 14-30 years were included. The patients were treated with anti-thymocyte immunoglobulin(ATG) combined with cyclosporine A(CsA)(29 cases, IST group) or HID-HSCT(26 cases, HID-HSCT group). Results The complete response(CR) rates in the IST and HID-HSCT groups were 58.6% vs 84.6%(P=0.034), and the overall response(OR) rates were 86.2% vs 84.6%. No significant difference was found in estimated 5-year overall survival(IST 77.9%±11.7% vs HID-HSCT 82.1%±8.4%) and event-free survival(IST 67.6%±11.7% vs HID-HSCT 69.2%±9.1%). The relapse rate of the IST group was 3.4%, and the clonal transformation rate was 13.8%. In HID-HSCT group, the relapse and clonal transformation rates were both 0%, and the incidence rates of grades 2-4 aGVHD and cGVHD were 19.2% and 15.4% respectively. The hospitalization expenses were significantly less in the IST group than in that of HID-HSCT group(median 168 000 yuan vs 378 000 yuan, P<0.001). Conclusions IST shows similar OR, OS and EFS but much less expense comparing with that of HID-HSCT. IST remains an appropriate choice for young SAA patients without sibling donors.

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