ORIGINAL RESEARCH article
Front. Immunol.
Sec. Alloimmunity and Transplantation
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1623004
This article is part of the Research TopicAllo-HSCT: novel clinical applications and therapeutic strategies in adults and analysis of rare procedure complicationsView all articles
Platelet Transfusion Refractoriness Within One Month Post-Hematopoietic Stem Cell Transplantation Does Not Impair Survival in Aplastic Anemia Patients After Engraftment: A Propensity Score-Matched Analysis
Provisionally accepted
Yuanfeng Zhang1
Yan Wang1
Li Liu2
Tingting Zhang2
Jiali Sun2Xin Chen2
Donglin Yang2
Aiming Pang2Rongli Zhang2Qiaoling Ma2
Weihua Zhai2
Yi He2Jialin Wei2
YIGENG CAO2Chen Liang2
Erlie Jiang2
Mingzhe Han2
Sizhou Feng2*- 1The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
- 2National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, tianjin, China
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The incidence of platelet transfusion refractoriness (PTR) and its impact on survival outcomes in patients with severe aplastic anemia (SAA) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. In this retrospective study, we investigated the incidence of early PTR (within one month post-allo-HSCT) and its clinical implications in 215 aplastic anemia (AA) patients. Among the enrolled patients, 24 (11.7%) developed PTR within the first month post-transplantation. Propensity score matching (PSM) was performed, resulting in 24 PTR cases and 96 matched non-PTR controls, with balanced baseline characteristics. No significant differences were observed between the two groups in bloodstream infections, grade II-IV or III-IV acute graft-versus-host disease (aGVHD), viral infections, or engraftment rates. However, PTR patients required significantly more red blood cell (median: 13.5 units vs. 8 units, P = 0.003) and platelet transfusions (median: 10.5 units vs. 5 units, P < 0.001) compared to non-PTR patients. The 3-year overall survival (OS) rate was numerically lower in the PTR group (66.7%; 95% CI, 44.3-81.7) than in the non-PTR group (81.2%; 95% CI, 71.1-88.0), although this difference was not statistically significant (P = 0.106). Multivariate analysis identified haploidentical donor and patient age as independent risk factors for OS. Our findings suggest that early PTR occurs at a relatively low frequency (11.7%) in AA patients post-allo-HSCT and may not significantly compromise survival outcomes following successful engraftment.
Keywords: aplastic anemia, Transplantation, Platelet transfusion refractoriness, Propensity Score, Survival
Received: 05 May 2025; Accepted: 07 Jul 2025.
Copyright: © 2025 Zhang, Wang, Liu, Zhang, Sun, Chen, Yang, Pang, Zhang, Ma, Zhai, He, Wei, CAO, Liang, Jiang, Han and Feng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sizhou Feng, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, tianjin, China
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