First-line choice for severe aplastic anemia in children: Transplantation from a haploidentical donor vs immunosuppressive therapy

Clinical Transplantation
Yifei ChengLan-Ping Xu

Abstract

We retrospectively compared the outcomes of children with severe aplastic anemia (SAA) who received immunosuppressive therapy (IST) or who underwent hematopoietic stem cell transplantation (HSCT) from a haploidentical donor (HID), between 2007 and 2016. A total of 52 children with SAA under the age of 17 years were initially treated with IST (n = 24) or haploidentical HSCT (n = 28) as first-line treatment. The estimated 10-year overall survival was 73.4 ± 12.6% and 89.3 ± 5.8% in patients treated with IST or HID-HSCT (P = .806). The failure-free survival was significantly inferior in patients receiving IST than in those undergoing transplantation from an HID (52.6 ± 10.5% vs 89.3 ± 5.8, P = .008). In univariate and multivariate analysis, the choice of first-line immunosuppressive therapy was the only adverse predictor for failure-free survival. At the last follow-up, completely normal blood count was observed in 11 of 20 (55.0%) and 24 of 25 (96.0%) live cases in IST and HID-HSCT cohort (P = .003). These suggest that HSCT from a haploidentical donor could be considered as first-line treatment in children who lack a matched related donor, especially in experienced transplantation centers.

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Citations

Oct 26, 2018·The New England Journal of Medicine·Neal S Young
Dec 17, 2020·Bone Marrow Transplantation·Zheng-Li Xu, Xiao-Jun Huang
Aug 4, 2021·Transfusion clinique et biologique : journal de la Société française de transfusion sanguine·Y-Y NiuT Wang
Aug 8, 2019·Acta Haematologica·Hawk KimUNKNOWN on behalf of the Korean Society of Blood and Marrow Transplantation

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