Impact of pre- and post-transplant transfusion requirements on outcomes in severe aplastic anemia patients

Abstract Background: Severe Aplastic Anemia (SAA) is well recognized life threatening hematological disorder characterized by pancytopenia with hyopcellular marrow without evidence of malignant infiltration or fibrotic changes. Objective: The goal of this research was to assess the effects of the pre- and post-transplant transfusion requirements on the outcomes of SAA patients who underwent HSCT. Study Design: This is a retrospective design study. Duration and Place of the study: This study was conducted at Gambat Institute of Medical Sciences specializing in hematology and BMT, between 1st, December 2018 to 2nd, January 2023. Material and Methods: Total Patients were 84, in which 45 patients were diagnosed with SAA who have undergone HSCT. Data were extracted regarding demographic features, transfusion history, transplant outcomes, and post-transplant complications. Patients were categorized into two groups: Group A (≤20 transfusions) and Group B (>20 transfusions). The diagnosis of Severe Aplastic Anemia is made using recognized criteria, which include a bone marrow cellularity of less than 25%, and the presence of at least two of the following: an absolute neutrophil count of less than 500/µL, a platelet count of less than 20,000/µL, or a reticulocyte count of less than 20,000/µL. Results: The study group consisted of individuals aged 4 to 41 years, with a higher proportion of males, having a male-to-female ratio of 1.2:1. Majority of the patients had a sibling donor (97.8%) while fewer had unrelated (2.2%) donor. Group A demonstrated superior outcomes with a 5-year overall survival of 84.0% compared to 60.0% in Group B (p=0.02). Graft failure (4.0% vs. 20.0%, p=0.03), severe infections (12.0% vs. 30.0%, p=0.01), iron overload (8.0% vs. 25.0%, p=0.04), and alloimmunization (12.0% vs. 30.0%, p=0.03) were significantly lower in Group A. Conclusion: Transfusion burden before and after HSCT is strongly associated with adverse outcomes in SAA patients. Strategies to minimize transfusion dependency may improve transplant success and survival. Keywords: HSCT, Severe aplastic anemia, Transfusion Requirements, Graft Failure.