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The haematopoietic cell transplantation comorbidity index predicts clinical outcomes for severe aplastic anaemia patients after haploidentical haematopoietic stem cell transplantation

Bone Marrow Transplantation volume 60, pages 573–580 (2025)Cite this article

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Abstract

To validate the ability of the haematopoietic cell transplantation comorbidity index (HCT-CI) to predict the outcomes of patients with severe aplastic anaemia (SAA) receiving haploidentical haematopoietic stem cell transplantation (haplo-HSCT), we conducted a retrospective study including 530 SAA patients. Patients were stratified based on their HCT-CI scores into three distinct risk categories: low-risk (HCT-CI scores of 0, n = 343), intermediate-risk (HCT-CI scores of 1, n = 126), and high-risk groups (HCT-CI scores ≥ 2, n = 61). The 100-day platelet engraftment rate was significantly higher in the low-risk group compared to the intermediate-risk and high-risk groups (92.1% vs. 86.5% vs. 83.6%, P = 0.014). In addition, compared with the intermediate-risk and high-risk groups, the low-risk group demonstrated superior 5-year overall survival (OS, 91.8% vs. 83.3% vs. 70.1%, P < 0.001) and graft-versus-host disease-free/graft failure-free survival (GFFS, 80.1% vs. 71.3% vs. 63.6%, P = 0.009). Multivariate analysis revealed that elevated HCT-CI scores and previous antithymocyte globulin treatment were independent risk factors for OS, whereas elevated HCT-CI scores and donor age ≥ 40 years were correlated with worse GFFS. Consequently, the HCT-CI is associated with the clinical outcomes of SAA patients following haplo-HSCT, and it is imperative to closely monitor patients with a high comorbidity burden.

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Fig. 1: Haematopoietic cell engraftment according to HCT-CI.
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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This work was partly supported by the National Natural Science Foundation of China (No. 82100227), Peking University People’s Hospital Research and Development Funds (RS2023-02), and Clinical Medicine Plus X - Young Scholars Project of Peking University, the Fundamental Research Funds for the Central Universities (PKU2024LCXQ001).

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Authors and Affiliations

  1. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Cell and Gene Therapy for Hematologic Malignancies, Peking University, Beijing, China

    Ming-Hao Lin, Xiao-Jun Huang, Lan-Ping Xu, Yu Wang, Xiao-Hui Zhang, Yi-Fei Cheng, Yuan-Yuan Zhang, Xiao-Dong Mo, Yu-Qian Sun, Ting-Ting Han, Jing-Zhi Wang, Yao Chen, Yu-Hong Chen, Huan Chen, Wei Han & Zheng-Li Xu

  2. Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China

    Xiao-Jun Huang

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Contributions

XJH and ZLX conceived and designed the research. YW, XHZ, YFC, YYZ, XDM, YQS, TTH, JZW, YC, YHC, HC, and WH collected patient data. ZLX, MHL, and LPX analyzed the data and wrote the manuscript. All authors critically reviewed and approved the final version of the manuscript.

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Correspondence to Zheng-Li Xu.

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Lin, MH., Huang, XJ., Xu, LP. et al. The haematopoietic cell transplantation comorbidity index predicts clinical outcomes for severe aplastic anaemia patients after haploidentical haematopoietic stem cell transplantation. Bone Marrow Transplant 60, 573–580 (2025). https://doi.org/10.1038/s41409-025-02513-5

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