This study aimed to evaluate the outcomes of second haploidentical hematopoietic stem cell transplantation (HID-HSCT) for patients with severe aplastic anaemia (SAA) who experienced graft failure. Twenty-one SAA patients with graft failure after first allogeneic (allo-) HSCT were enrolled, including 6 (28.6%) with poor graft function and 15 (71.4%) with graft rejection. Two patients developed primary graft failure after the second transplantation, and the cumulative incidence of neutrophil recovery was 81.0% ± 0.9%, with a median recovery of 13 days (range, 10-23 days). The cumulative incidences of grade II-IV and III-IV acute graft-versus-host disease (GvHD) were 19.0% ± 0.8% and 4.8% ± 0.2%, respectively. The cumulative incidences of chronic GvHD (cGvHD) at three and five years were both 24.5% ± 1.0%, with no severe cGvHD cases. The 5-year overall survival (OS) rate was 47.1% ± 11.0%, with a median follow-up of 2037.5 days (range, 863-3488 days) among survivors. Multivariate logistic regression analysis identified not changing a donor (P = 0.019) as the only adverse factor for graft failure after the second HID-HSCT. Moreover, changing a donor (P = 0.004), compatible donor-recipient blood type (P = 0.005), and patient age < 12 years (P = 0.038) at the second transplantation were significant predictors of improved OS. These findings suggest that a second HID-HSCT could be a feasible option for treating graft failure in SAA patients.
Keywords: Aplastic anaemia; Graft failure; Haploidentical; Second HSCT.
© 2025. The Author(s).