Delay in cell infusion improves GVHD and clinical outcomes in severe aplastic anemia patients ˃30 years receiving unrelated donor hematopoietic stem cell transplantation

May 1, 2026Blood cells, molecules & diseases

Delaying cell infusion may improve graft-versus-host disease and outcomes in severe aplastic anemia patients over 30 receiving unrelated donor stem cell transplants

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Abstract

In a study of 177 severe aplastic anemia patients, 5.7% experienced grade III-IV graft-versus-host disease (GVHD) with early infusion compared to 0% with late infusion.

No significant differences were found in neutrophil or platelet engraftment rates between early and late infusion groups.
Incidences of acute and chronic graft-versus-host disease, as well as cytomegalovirus and Epstein-Barr virus viremia, did not differ significantly by infusion timing.
Older patients over 30 years receiving late infusion had a higher overall survival rate of 97% compared to 78% for those infused early.
Failure-free survival rates were also better for older patients receiving late infusion (94% vs. 78%).
These findings suggest that the timing of hematopoietic stem cell infusion may influence GVHD risk and survival outcomes in older patients.

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Circadian rhythms regulate immune cell activity, but their impact on hematopoietic stem cell infusion remains unclear. This retrospective study evaluated 177 severe aplastic anemia (SAA) patients undergoing unrelated donor hematopoietic stem cell transplantation (URD-HSCT) (2012-2023) to assess impacts of circadian infusion timing. No significant differences emerged between early and late infusion groups in cumulative incidence (CUI) of neutrophil/platelet engraftment, acute/chronic graft-versus-host disease (aGVHD/cGVHD), or CMV/EBV viremia. Notably, CUI of grade III-IV aGVHD was higher in the early group (5.7%, 95% CI: 1.8%-13.4%) versus 0% in the late group (95% CI: 0%-3.4%, P = 0.03). Five-year overall survival (OS: 87% vs. 93%, P = 0.1871), failure-free survival (FFS: 85% vs. 92%, P = 0.1389), and graft-versus-host disease/relapse-free survival (GRFS: 76% vs. 82%, P = 0.2781) showed no statistical disparities. Subgroup analysis revealed older patients (>30 years) receiving late peripheral blood HSCT had superior OS (78% vs. 97%, P = 0.0154) and FFS (78% vs. 94%, P = 0.0390). These data suggest that the timing of infusion may affect the risk of GVHD and the survival of older patients, for whom delayed infusion may confer a survival benefit.

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Delay in cell infusion improves GVHD and clinical outcomes in severe aplastic anemia patients ˃30 years receiving unrelated donor hematopoietic stem cell transplantation

Abstract

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