Clinical Research Of Haploidentical Hematopoietic Stem Cell Transplantation For Myelodysplastic Syndrome Evolved From Aplastic Anemia

Objective To evaluate the efficiency and safety of haploidentical hematopoietic stem cell transplantation(haplo-HSCT)for treatment of secondary myelodysplastic syndrome(sMDS)after aplastic anemia(AA).Methods Consecutive patients diagnosed sMDS evolved from AA with prior immunosuppressive therapy who received haplo-HSCT(n=5)from ABO matched donors(n=3),ABO major mismatched donor(n=1)or ABO minor mismatched donor(n=1)from January 2006 to September 2017 were analyzed.Patients received mBuCy-ATG±decitabine/cladribine or FluCy-ATG in haplo-HSCT as conditioning regimens followed by peripheral blood transplantation.We evaluated therapeutic effect,incidence rate of acute GVHD and chronic GVHD,complications and overall survival of these patients.Results All patients achieved neutrophil and platelet engraftment at a median of 18 days(range from 14 to 22 days)and 21 days(range from 15 to 65 days)respectively.60%(3/5)patients occurred ?~?° aGVHD with no ?°aGVHD,and 20%(1/5)with cGVHD.Of 5 patients,all patients occurred neutropenic fever,1(20%)with lung fungal infection,2(40%)with sepsis,3(60%)with EB infection and 3(60%)with CMV infection,2(40%)with hemorrhagic cystitis,1(20%)with engraftment syndrome,1(20%)with epileptic like symptom and 1(20%)with axillary venous thrombosis.2 patients(40%)died due to uncontrollable infection and hemorrhagic tendency followed by Cardiac pulmonary sudden stop.Median OS was 63 months(range from 41.9 to 149.3 months),OS after HSCT was 12.9 months(range from 2.4 to 36.5 months).One-year event free survival was 60%.Median OS of survivals was 44.8 months(range from 41.9 to 63 months),OS after HSCT of survivals was 29.6 months(range from 12.9 to 36.5 months)followed until April 6,2018.Conclusions Haplo-HSCT can be an efficient and safe option for AA-post MDS patients in case of an HLA-identical donor is not available.