Clinical Observation Of Allogeneic Hematopoietic Stem Cell Transplantation In Treatment Of 24 Cases Of Transfusions Dependent Non-severe Aplastic Anemia

Objective: Transfusion dependent nonsevere aplastic anemia(TD-NSAA)refers to the NSAA that meets SAA in blood routine before it develops into SAA and needs to rely on blood transfusion.International AA guidelines recommend TD-NSAA for immunosuppressive therapy with anti-thymocyte globulin(ATG)combined with cyclosporine A(Cs A).But its effect is slow,easy to co-infection and the recurrence rate is high.Allogeneic hematopoietic stem cell transplantation(Allo-HSCT)is an effective treatment.For patients lacking HLA-matched sibling donors,haploidentical stem cells transplantation(Haplo-HSCT)has greatly alleviated the shortage of hematopoietic stem cell donors.The purpose of this study was to retrospectively analyze the clinical data of TD-NSAA patients who received Allo-HSCT treatment,and to compare the clinical efficacy and survival of patients who received Haplo-HSCT during the same period,and to evaluate the safety and feasibility of clinical treatment.Methods: In this study,we collected the 24 TD-NSAA patients in the Second Hospital of Hebei Medical University from September 2016 to June2020 were collected and analyzed,and clinical data including clinical treatment and implantation prognosis were retrospectively analyzed.The conditioning regimens were Busulfan/ cyclophosphamide+ Fludarabine+ ATG.The prevention and treatment of Graft-versus-host disease(GVHD)were Cs A+mycophenolate mofetil+ short-term methotrexate.Patients were followed up to observe the incidence of complications such as hematopoietic reconstruction,implantation,infection and GVHD as well as their overall survival.Results: Results of hematopoietic function reconstruction: the success rate of implantation was 91.67%.The median survival time for neutrophils was11(8-20)days and for platelets 12.5(10-22)days after transplantation.By the end of follow-up: 10 of the 24 patients developed AGVHD after transplantation,the median time of onset was 22.5(20-99)days after transplantation,and 12 patients developed chronic GVHD.Bacteremia occurred in 1 patient(4.17%),CMV in 12 patients(50%),EBV in 11 patients(45.83%),invasive fungal infection in 10 patients(41.67%)and skin and soft tissue infection in 1patient(4.17%).Conclusions:1.All O-HSCT is a safe and effective method for the treatment of TD-NSAA,and can be used as a treatment regimen for TD-NSAA.2.The overall survival rate of TD-NSAA treated by haplo-HSCT was not statistically significant difference compared with HLA-matched HSCT.3.In the treatment of TD-NSAA by Allo-HSCT,there was no significant difference in the overall survival rate and the incidence of other complications after transplantation between adult and child groups.4.In the treatment of TD-NSAA with Allo-HSCT,the incidence of posttransplantation complications and GVHD is high.