Abstract

Graft failure (GF) is the most critical life- hanging complication of allogeneic hematopoietic stem cell transplantation (HSCT) for aplastic anemia, for which a alternate transplantation is the only effective treatment. Optimal procedures haven't been established for the alternate transplantation in this setting, still. Then we retrospectively anatomized the issues of 22 cases with aplastic anemia, age ≥ 16 times, who passed umbilical cord blood transplantation for GF after the first HSCT using the registry database of the Japan Society for Hematopoietic Cell Transplantation. The median age of cases was 36 times (range, 16 to 72 times), and the median time from the first to the alternate transplant was 77 days (range, 29 to 1061 days). The accretive prevalence of neutrophil engraftment at day 60post-transplantation was45.5 (95 confidence interval (CI), 23.6 to65.0). With a standard follow- up of 50 months, the 4- time overall survival (zilches) was38.5 (95 CI, 18.4 to58.5). Mycophenolate mofetil – grounded graft- versus- host complaint prophylaxis demonstrated lesser neutrophil recovery than prophylaxis with calcineurin asset alone or methotrexate- grounded prophylaxis (66.7 versus37.5; P = .04). The use of similar exertion rules as fludarabine melphalan or cyclophosphamide low- cure total body irradiation was associated with better engraftment(58.3 versus 30; P = .05) and better 4- time OS(55.6 versus 20; P = .05) than other rules. Although farther disquisition is demanded, umbilical cord blood could be an effective and promising option for stem cell source for critical alternate transplantation in cases with aplastic anemia that develop GF after the first HSCT.