Journal
FRONTIERS IN IMMUNOLOGY
Volume 13, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fimmu.2022.912917
Keywords
Severe aplastic anemia; Haploidentical donor; hematopoietic stem cell transplant; unrelated cord blood; Comparision
Categories
Funding
- National Key R&D Program of China [2016YFC0902800, 2017YFA0104502, 2017ZX09304021]
- Innovation Capability Development Project of Jiangsu Province [BM2015004]
- Jiangsu Provincial Key Medical Center [YXZXA2016002]
- Jiangsu Medical Outstanding Talents Project [JCRCA2016002]
- Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD)
- Science Foundation of Suzhou [SKY2021040]
- Open Project of Jiangsu Biobank of Clinical Resources [SBK202003003]
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This study compares the feasibility and efficacy of haploidentical hematological stem cell transplantation combined with a single unrelated cord blood infusion and haplo-identical HSCT alone in severe aplastic anemia patients. The findings suggest that the coinfusion of a single UCB potentially improves survival of Haplo-HSCT, and an HLA-A allele-matched UCB is the preferred option.
The purpose of this study in severe aplastic anemia (SAA) patients was to compare the feasibility and efficacy of haploidentical hematological stem cell transplantation combined with a single unrelated cord blood (UCB) infusion (Haplo-cord-HSCT) or haplo-identical HSCT (Haplo-HSCT) alone. The five-year graft-versus-host disease (GVHD)-free or failure-free survival (GFFS) was similar between the two groups (72.4 +/- 3.4% vs. 65.4 +/- 5.2%, P = 0.178); however, the five-year overall survival (OS) was more favorable in the Haplo-cord-HSCT group than that in the Haplo-HSCT group (84.0 +/- 2.8% vs. 72.6 +/- 4.9%, P = 0.022), as was transplantation-related mortality (16.4% vs. 27.4%, P = 0.039). Multivariate analysis showed that Haplo-cord HSCT was the only independent determinant of increased OS (P = 0.013). Explorative subgroup analysis showed that only an Human leukocyte antigen-A (HLA-A) allele match between UCB and the recipient was a beneficial factor for GFFS in the Haplo-cord-HSCT group (P = 0.011). In the haplo-cord with an HLA-A match (n = 139) or mismatch (n = 32) or Haplo-HSCT groups, a haplo-cord HLA-A allele match was associated with lower I-IV and III-IV acute GVHD. The haplo-cord with an HLA-A match subgroup also had higher five-year OS than the Haplo-HSCT group (85.4 +/- 3.0% vs. 72.6 +/- 4.9%, P = 0.013), and higher five-year GFFS than the Haplo-cord HLA-A allele mismatch subgroup (76.2 +/- 3.6% vs. 56.3 +/- 8.8%, P = 0.011). These findings suggest that the coinfusion of a single UCB potentially improves survival of Haplo-HSCT in SAA patients and that an HLA-A allele-matched UCB is the preferred option.
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