Severe aplastic anemia patients with infection who received an allogeneic hematopoietic stem cell transplantation had a better chance: Long-term outcomes of a multicenter study

Abstract

Background and aimsHow to select the treatment is a challenge for the management of acquired patients with infections. This study aimed at comparing the outcomes of SAA with infections who had an allogeneic hematopoietic stem cell transplantation (allo-HSCT)with that of patients who had an infection and received non-HSCT therapy.MethodsWe retrospectively compared the outcomes of patients with acquired SAA and infections who had an allo-HSCT (n = 141) with that of patients who had an infection and received non-HSCT therapy (n = 186) between July 2004 and January 2020.ResultsThe treatment-related mortality (TRM) of grade 1-2 infections in the HSCT and non-HSCT groups was 24.99% and 13.68%, respectively (P = 0.206), while the TRM of grade 3-4 infections was lower in the HSCT group than that observed in the non-HSCT group (18.54% vs. 33.33%, P = 0.036). At 6 months post-treatment, 91.30% patients in the HSCT group and 8.78% patients in the non-HSCT group had achieved a normal blood profile (P < 0.0001). The time required to discontinue transfusions of red blood cells and platelets in the non-HSCT group was longer than in the HSCT group (P < 0.0001). Estimated overall survival (OS) at 6 years was similar in the two groups (75.5% ± 3.9% vs. 76.3% ± 3.1%, P = 0.996), while the estimated failure-free survival (FFS) at 6 years was 75.2% ± 3.8% in the HSCT group and 48.9% ± 3.7% in the non-HSCT group (P < 0.0001). Multivariate analysis showed that younger age, lower grade of infection (grade 1-2), and SAA (vs. very SAA) were favorable factors for OS (P < 0.05), and that the choice of HSCT and younger age were favorable factors for FFS (P < 0.0001).ConclusionThese results suggest that allo-HSCT has a better chance of a successful outcome than non-HSCT in SAA patients with an infection.

Development and validation of early death risk score model for emergency status prediction in very severe aplastic anemia

“…Another study by the European Society for Blood and Marrow Transplantation (EBMT) (11) found the 10-year OS in VSAA patients treated with IST to be 73%, which is similar to our results. A Chinese study (12) also found that SAA and VSAA patients who underwent HSCT versus those who did not have comparable 6-year OS rates at 75.5% and 76.3%, respectively. Hu et al (13) found that patients with AA undergoing first-line IST had an early-death rate of 7.6%, with 86% of the early death occurring in those with VSAA.…”

“…But hematopoietic recovery after IST treatment often took at least 3 months ( 20 ), during which the patients were at risk for early death and loss of the opportunity for salvage therapy. In contrast, HSCT can restore neutrophils earlier and provide patients with a better chance of survival ( 12 ).…”

TERC haploid cell reprogramming: a novel therapeutic strategy for aplastic anemia

“…Clinically, HSC transplantation is mainly used to compensate for the lack of HSCs in patients with AA. However, there are complications associated with transplantation, such as graft-versus-host disease and risk of infection; therefore, the prognosis for patients with AA remains unsatisfactory (Liu et al 2022 ). The identification of cells with strong differentiation abilities would be extremely beneficial in the development of novel therapeutic strategies in clinical practice.…”

Studying the pathogenicity of 26 variants characterized in the first molecular analyses of Egyptian aplastic anemia patients

“…Relapse and clonal evolution are also obstacles in IST [ 9 , 10 ]. Therefore, AA patients still have unfavorable prognoses [ 11 ].…”