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To determine whether a waiting time\u2009&gt;\u20091 year from diagnosis to first allo-HSCT compromises engraftment, virus reactivation, GVHD, OS and GRFS in SAA. A single-center retrospective cohort study of 255 consecutive SAA patients receiving their first allo-HSCT between 2018 and 2025. After 1:2 propensity-score matching (caliiper 0.2), patients were stratified into Early (\u2264\u20091 year,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009170) and Delayed (&gt;\u20091 year,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200985) groups. Baseline characteristics were well balanced. The Early group exhibited a significantly lower CMV reactivation rate (24.1% vs. 40.0%,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.008). No significant differences were observed in grade II-IV aGVHD, cGVHD, 5-year OS or GRFS. Subgroup analyses demonstrated superior survival among patients aged\u2009\u2264\u200940 years, those with MSD donors and received FABT-based regimen. Early allo-HSCT improves transplant outcomes in SAA by reducing CMV reactivation, especially in very severe cases. Eligible patients should be referred promptly and transplanted without delay.\n                  <\/jats:p>","DOI":"10.1007\/s00277-026-06869-6","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T01:20:25Z","timestamp":1773796825000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of clinical outcomes between early and delayed allogeneic hematopoietic stem cell transplantation for severe aplastic anemia: a single-center retrospective study"],"prefix":"10.1007","volume":"105","author":[{"given":"Zhengwei","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuechao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huijin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghong","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tonglin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dijiong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baodong","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"11","key":"6869_CR1","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1182\/blood-2016-08-693481","volume":"129","author":"A Bacigalupo","year":"2017","unstructured":"Bacigalupo A (2017) How I treat acquired aplastic anemia[J]. 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