{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:53:07Z","timestamp":1791175987513,"version":"4.1.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012232","name":"National Key Clinical Specialty Discipline Construction Program of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100012232","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe aplastic anemia (SAA) is a fatal bone marrow failure disorder. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the definitive curative treatment for SAA. This study evaluated the prognosis of patients with severe aplastic anemia (SAA) receiving different allo-HSCT regimens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was performed on 62 patients with aplastic anemia who underwent allo-HSCT between January 2015 and August 2024. The cohort comprised 32 males and 30 females, with a median age of 12 years (range, 1.5\u201344 years) at transplantation; 28 patients were \u226514 years old and 34 were &amp;lt;14 years. Forty-eight patients were diagnosed with severe AA (SAA) and 14 with very severe AA (VSAA). Twenty-two patients underwent HLA-matched sibling donor transplantation(MSD-HSCT), and 40 underwent HLA-haploidentical sibling donor transplantation(Haplo-HSCT).Three conditioning regimens were administered: cyclophosphamide plus anti-thymocyte globulin (CY+ATG, CA, n=11), fludarabine + cyclophosphamide + ATG (Flu+CY+ATG, FCA, n=26), and fludarabine + melphalan + ATG (Flu+Mel+ATG, FMA, n=25).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median follow-up duration of the 62 patients was 38 months (range: 0\u2013136 months). Twelve deaths occurred during follow-up. Post-transplant complications included post-transplant lymphoproliferative disorder (PTLD) in 3 patients (4.84%), acute graft-versus-host disease (aGVHD) in 7 patients (11.29%), chronic GVHD (cGVHD) in 2 patients (3.23%), Epstein-Barr virus (EBV) viremia in 10 patients (16.13%), and invasive fungal disease in 1 patient (1.62%). The median time to neutrophil engraftment was 13 days (evaluable in 55 patients). Kaplan-Meier survival analysis revealed no statistically significant difference in 5-year overall survival (OS) between MSD-HSCT and Haplo-HSCT groups (P\u00a0=\u00a00.582). The 5-year OS rate was 76.8% for the MSD-HSCT (n=22) and 80.6% for the Haplo-HSCT group (n=40). No significant intergroup difference in 5-year OS was detected across the three conditioning regimens (P\u00a0=\u00a00.85); the 5-year OS rates of the CA, FCA, and FMA groups were 81.6%, 76.8%, and 84.0%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>(1)MSD-HSCT and Haplo-HSCT yield comparable 5-year OS. Haploidentical related donors serve as a reliable alternative when fully matched donors are unavailable. (2) No statistically significant difference in 5-year overall survival (OS) was observed among the CA, FCA, and FMA conditioning regimens. (3) the FMA regimen may be considered as a favorable alternative to avoid the cyclophosphamide related toxicities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1936533","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:35:41Z","timestamp":1791174941000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative prognostic analysis of allogeneic hematopoietic stem cell transplantation regimens in the treatment of severe aplastic anemia"],"prefix":"10.3389","volume":"17","author":[{"given":"Ting","family":"Lin","sequence":"first","affiliation":[{"name":"Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology,FUjian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianlin","family":"Chen","sequence":"additional","affiliation":[{"name":"Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology,FUjian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohong","family":"Yuan","sequence":"additional","affiliation":[{"name":"Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology,FUjian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijuan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology,FUjian Medical University Union Hospital","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nainong","family":"Li","sequence":"additional","affiliation":[{"name":"Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology,FUjian Medical University Union Hospital","place":["Fuzhou, China"]},{"name":"Translational Medicine Center on Hematology, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofan","family":"Li","sequence":"additional","affiliation":[{"name":"Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology,FUjian Medical University Union Hospital","place":["Fuzhou, China"]},{"name":"Translational Medicine Center on Hematology, Fujian Medical University","place":["Fuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/cbin.11689","article-title":"Aplastic anemia, cellular and molecular aspects","volume":"45","author":"Javan","year":"2021","journal-title":"Cell Biol Int"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1080\/17474086.2017.1302797","article-title":"Why is the incidence of aplastic anemia higher in 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acquired severe aplastic anemia? experience from a multicenter study","volume":"12","author":"Xu","year":"2019","journal-title":"J Hematol Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1173320","article-title":"Low-dose post-transplant cyclophosphamide with G-CSF\/ATG based haploidentical protocol provides favorable outcomes for SAA patients","volume":"14","author":"Ma","year":"2023","journal-title":"Front Immunol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019000722","article-title":"Choice of conditioning regimens for bone marrow transplantation in severe aplastic anemia","volume":"25","author":"Bejanyan","year":"2019","journal-title":"Biol Blood Marrow Transplant"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.issn.0253-2727.2014.03.016","article-title":"Clinical study of allogeneic hematopoietic stem cell transplantation with fludarabine-containing intensified conditioning regimen in 22 patients with severe aplastic anemia","volume":"35","author":"Sun","year":"2014","journal-title":"Chin J Hematol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-014-1501-6","article-title":"A combination of fludarabine, half-dose cyclophosphamide, and anti-thymocyte globulin is an effective conditioning regimen before allogeneic stem cell transplantation for aplastic anemia","volume":"99","author":"Ashizawa","year":"2014","journal-title":"Int J Hematol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbmt.2010.08.013","article-title":"Fludarabine-based conditioning chemotherapy for allogeneic hematopoietic stem cell transplantation in acquired severe aplastic anemia","volume":"17","author":"Al-Zahrani","year":"2011","journal-title":"Biol Blood Marrow Transplant"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023020435","article-title":"Alternative donor BMT with posttransplant cyclophosphamide as initial therapy for acquired severe aplastic 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Kunming, Yunnan\n          Kunming Medical University\n          Clinical study of modified post-transplant cyclophosphamide regimen for aGVHD prophylaxis after haploidentical HSCT in patients with aplastic anemia\n          \n          2022"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1038\/s41409-996-0099-8","article-title":"Melphalan alone prior to allogeneic bone marrow transplantation from HLA-identical sibling donors for hematologic malignancies: alloengraftment with potential preservation of fertility in women","volume":"18","author":"Singhal","year":"1996","journal-title":"Bone Marrow Transplant"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24922","article-title":"Fludarabine, cytarabine, granulocyte colony-stimulating factor and melphalan (FALG with L-PAM) as a reduced toxicity conditioning regimen","volume":"114","author":"Kato","year":"2021","journal-title":"Int J Hematol"}],"container-title":["Frontiers in 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