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Clinical outcomes of offspring and matched unrelated donor transplants in relapsed or refractory severe aplastic anemia patients aged 40–50: a retrospective analysis from the CBMTR over the past decade

Bone Marrow Transplantation volume 60, pages 1282–1285 (2025)Cite this article

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Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the sole curative treatment for severe aplastic anemia (SAA) [1]. When immunosuppressive therapy fails and a matched sibling donor (MSD) is unavailable, alternative donor transplantation (ADT) is recommended for SAA patients under 50 years old [1]. However, searching and identifying a suitable matched unrelated donor (MUD) for transplantation is a time-consuming process, typically taking three to six months [2]. In contrast, the immediate availability of haploidentical donors and their successful use in transplantation have expanded treatment options for SAA patients [3]. Notably, patients aged 40–50 often have at least one child who is young and readily available as a donor. Several studies have identified older donors to be a risk factor influencing graft-versus-host disease (GvHD), transplant-related mortality (TRM), and survival [4]. Wang et al. indicated that young offspring donors achieve superior outcomes compared to older MSDs in older patients with hematological malignancies [5]. Within the large haploidentical donor pool, our recent study has shown that in SAA patients aged 40–50 years, offspring transplants achieved higher 3-year overall survival (OS) possibilities than haploidentical sibling donors (77.9 ± 3.9% vs. 69.3 ± 7.6%) [6]. However, the outcomes of allo-HSCT in relapsed/refractory (rel/ref) SAA patients older than 40 years, particularly the survival advantages of young offspring donors in this age group, have rarely been reported.

Based on data from the Chinese Blood and Marrow Transplant Registry (CBMTR), we analyzed the outcomes of SAA patients between 40 and 50 years, who underwent a salvage allo-HSCT from November 2013 to December 2022. A total of 80 patients were enrolled. The study was approved by each institutional review board at the 18 participating institutions. Data were obtained through a unified form sent to participating centers, and any inconsistencies in the data were addressed by contacting the center physicians directly. Refractory SAA was defined as blood counts satisfying the criteria for SAA 4 months following IST. Relapse was considered if the patient had a previous response following IST and once more became transfusion dependent or met criteria for SAA. Acute GvHD and chronic GvHD were graded following international criteria [7]. All transplant procedures followed established protocols for conditioning, graft-versus-host disease prophylaxis (GVHD), stem cell collection, and supportive care, as described in previous study [8]. The details of GvHD prophylaxis have been described previously [9]. The conditioning regimens for transplants from different donor types, as well as the methods of statistical analysis in our study are provided in Supplementary Method.

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Fig. 1: Survival outcomes post-transplantation.

Data availability

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

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Acknowledgements

We acknowledge all the patients included in the study.

Funding

This work was supported by the National Key Research and Development Program of China (2024YFC2510500).

Author information

Author notes

  1. These authors contributed equally: Xin Zhao, Yu-Ping Zhang.

Authors and Affiliations

  1. Peking University Institute of Hematology, Peking University People’s Hospital, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

    Xin Zhao, Xiao-Jun Huang & Lan-Ping Xu

  2. Department of Hematology, Guangzhou First People’s Hospital, Institute of Blood Transfusion and Hematology Guangzhou Medical University, Guangzhou, China

    Yu-Ping Zhang & Shun-Qing Wang

  3. Department of Hematology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China

    Bao-Dong Ye

  4. Department of Hematology, Beijing Lu Daopei Hospital, Beijing, China

    Pei-Hua Lu

  5. Department of Hematology, Southwest Hospital, Third Military Medical University, Chongqing, China

    Jie-Ping Chen

  6. Department of Hematology, Hebei Yanda Lu Daope Hospital, Langfang, Hebei, China

    Jian-Ping Zhang

  7. Department of Hematology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China

    Xin Li

  8. Department of Hematology, Cangzhou Central Hospital, Cangzhou, Hebei, China

    Guo-Hong Su

  9. Department of Hematology, Huai’an Second People’s Hospital, Huai’an, Jiangsu, China

    Yan-Ming Zhang

  10. State Key Laboratory of Experimental Hematology, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Disease Hospital, National Clinical Research Center for Blood Diseases, Chinese Academy of Medical Sciences & Peking Union Medical Science & Peking Union Medical College, Tianjin, China

    Er-Lie Jiang

  11. Department of Hematology, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, China

    Fang Zhou

  12. Department of Hematology, General Hospital of PLA (People’s Liberation Army of China), Beijing, China

    Dai-Hong Liu

  13. Department of Hematology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China

    Zi-Min Sun

  14. Department of Hematology, Tangdu Hospital Fourth Military Medical University, Xi’an, China

    Wei-Wei Qin

  15. Department of Hematology, The General Hospital of Western Theater Command, PLA, Chengdu, China

    Hai Yi

  16. Department of Hematology, Weifang People’s Hospital, Weifang, Shandong, China

    Xue-Hong Ran

  17. Department of Hematology, Xiangya Hospital of Central South University, Changsha, Hunan, China

    Ya-Jing Xu

  18. Department of Hematology, Xinqiao Hospital of Army Medical University (Third Military Medical University), Chongqing, China

    Xi Zhang

Authors
  1. Xin Zhao
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  2. Yu-Ping Zhang
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  3. Bao-Dong Ye
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  6. Jian-Ping Zhang
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  18. Xi Zhang
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  19. Xiao-Jun Huang
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  20. Shun-Qing Wang
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  21. Lan-Ping Xu
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Contributions

P Xu and SQ Wang: designed the research; X Zhao: analyzed the data and wrote the manuscript; YP Zhang, BD Ye, PH Lu, JP Chen, JP Zhang, X Li, GH Su, YM Zhang, EL Jiang, F Zhou, DH Liu, ZM Sun, WW Qin, H Yi, XH Ran, YJ Xu, X Zhang and XJ Huang: provided patient data and gave final approval for the manuscript.

Corresponding authors

Correspondence to Shun-Qing Wang or Lan-Ping Xu.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was approved by all ethics committees of participating centers, including the ethics committee of Peking University People’s Hospital. In accordance with the Declaration of Helsinki, written ethics committee approval and informed consent have been obtained from all patients/legal guardians.

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Zhao, X., Zhang, YP., Ye, BD. et al. Clinical outcomes of offspring and matched unrelated donor transplants in relapsed or refractory severe aplastic anemia patients aged 40–50: a retrospective analysis from the CBMTR over the past decade. Bone Marrow Transplant 60, 1282–1285 (2025). https://doi.org/10.1038/s41409-025-02617-y

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  • DOI: https://doi.org/10.1038/s41409-025-02617-y

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