Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Pregnancy-Associated Aplastic Anemia

The prognosis and management of pregnancy-associated aplastic anemia (PAA) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remain uncertain. This study evaluated the safety and feasibility of allo-HSCT in 18 patients with PAA who were treated between January 2013 and November 2023. The donor types included 8 matched sibling donors, 1 matched unrelated donor, 3 mismatched unrelated donors, and 6 haploidentical donors. Median neutrophil engraftment occurred at 11.5 days (range: 6-15), and platelet engraftment occurred at 11.5 days (range: 7-28). The cumulative incidence (CI) of both neutrophil and platelet engraftments was 100%. The CI rates were 22.96%±10.10% for grade II acute graft-versus-host disease (aGVHD) and 12.61%±8.37% for chronic GVHD (cGVHD). No cases of grade III-IV aGVHD, extensive cGVHD, or relapse were observed. The CI of transplantation-related mortality was 19.87%±10.49%. Among the 15 surviving patients, the median follow-up was 1,409 days (range: 228-3,666). The overall survival (OS) and relapse/rejection-free (GRFS) rates were both 80.14%±10.49%. These findings suggest that allo-HSCT is a viable and effective treatment option for PAA.