Platelet transfusion refractoriness within one month post-hematopoietic stem cell transplantation does not impair survival in aplastic anemia patients after engraftment: a propensity score-matched analysis

Abstract

Introduction: The incidence of platelet transfusion refractoriness (PTR) and its impact on survival outcomes in patients with severe aplastic anemia (SAA) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains unclear. Methods: We investigated the incidence of early PTR (within one month post-allo-HSCT) and its clinical implications in 215 aplastic anemia (AA) patients in a retrospective study. Results: Among the enrolled patients, 24 (11.7%) developed PTR within the first month post-transplantation. Propensity score matching (PSM) was performed, resulting in 24 PTR cases and 96 matched non-PTR controls, with balanced baseline characteristics. No significant differences were observed between the two groups in bloodstream infections, grade II–IV or III–IV acute graft-versus-host disease (aGVHD), viral infections, or engraftment rates. However, PTR patients required significantly more red blood cell (median: 13.5 units vs. 8 units, P = 0.003) and platelet transfusions (median: 10.5 units vs. 5 units, P < 0.001) compared to non-PTR patients. The 3-year overall survival (OS) rate was numerically lower in the PTR group (66.7%; 95% CI, 44.3–81.7) than in the non-PTR group (81.2%; 95% CI, 71.1–88.0), although this difference was not statistically significant (P = 0.106). Multivariate analysis identified haploidentical donor and patient age as independent risk factors for OS. Conclusion: Our findings suggest that early PTR occurs at a relatively low frequency (11.7%) in AA patients post-allo-HSCT and may not significantly compromise survival outcomes following successful engraftment.