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BACKGROUND: The probability of obtaining sibling-matched hematopoietic stem cell transplantation donors for patients with severe aplastic anemia is less than 30%. With the recent improvement of unrelated peripheral blood stem cell transplantation, the efficacy of unrelated peripheral blood stem cell transplantation in the treatment of benign and malignant hematological diseases has reached a result similar to that of sibling-matched hematopoietic stem cell transplantation. OBJECTIVE: To evaluate the efficacy and safety of unrelated peripheral blood stem cell transplantation in the treatment of severe aplastic anemia. METHODS: A retrospective analysis was made in 25 severe aplastic anemia (type I and type II) patients who received unrelated peripheral blood stem cell transplantation from March 2014 to September 2019. All of them were sibling-matched hematopoietic stem cell transplantation-free patients who refused to accept immunosuppressive therapy. The transplantation pretreatment regimen was “fludarabine + cyclophosphamide + rabbit anti-human thymocyte globulin antibody”, and the prevention scheme of graft-versus-host disease was “cyclosporine + mycophenolate mofetil + short-term methotrexate”. The observation indicators included implantation rate, hematopoietic reconstitution time, incidence of graft-versus-host disease, incidence of transplantation-related complications, 5-year estimated overall survival rate and 5-year estimated disease-free survival rate. This study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University. Patients and their family members signed the informed consent on unrelated peripheral blood stem cell transplantation. RESULTS AND CONCLUSION: (1) Three of the 25 patients died within 28 days after hematopoietic stem cell transplantation, and the implantation could not be evaluated. Of the remaining 22 patients, 21 cases (95.4%) obtained hematopoietic reconstitution and the implantation was successful; 1 case (4.6%) failed. The median time of neutrophil ≥ 0.5×109 L -1 and platelet ≥ 20×109 L -1 was 12 days (9-18 days) and 13 days (10-32 days), respectively. (2) Among the 21 patients with successful implantation, the incidence of acute graft-versus-host disease was 28.6% (6/21), including I-II degree in 3 cases and III–IV degree in 3 cases. There were only 9.5% patients with mild chronic graft-versus-host disease (2/21), and no moderate and severe chronic graft-versus-host disease occurred. (3) During the median follow-up of 396 days (15-1 886 days), 18 cases (72.0%) survived; the 5-year estimated overall survival rate was 71.1%; and the 5-year estimated disease-free survival rate was 65.6%. Totally 7 cases (28.0%) died, of which 3 cases (12.0%) died of infection, 2 cases (8.0%) died of acute intestinal graft-versus-host disease, 1 case (4.0%) died of intracranial hemorrhage, and 1 case (4.0%) died of multiple organ failure. (4) The results show that unrelated peripheral blood stem cell transplantation is a safe and effective treatment for severe aplastic anemia patients without sibling matching donor, and it is a feasible and useful alternative therapy. [ABSTRACT FROM AUTHOR]

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