Impact of Pre- and Post-Transplant Transfusion Requirements on Outcomes in SAA Patients

Abstract

Objective: The goal of this research shall be to assess the effects of the pre- and post-transplant transfusion requirements on the outcomes of SAA patients who underwent HSCT.

Methodology: This is a retrospective design study was conducted at Gambat Institute of Medical Sciences specializing in hematology and oncology, between 1st, December 2018 to 2nd, January 2023. 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.