Document Type
Article
Publication Title
Blood advances
Abstract
Severe aplastic anemia (SAA) is a rare and life-threatening bone marrow failure disorder. Immunosuppressive therapy (IST) with antithymocyte globulin and cyclosporine has long been a frontline treatment option in SAA; however, its limited durability and risk of long-term complications such as secondary malignancies remain a drawback in this treatment modality. Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative option with significantly improved outcomes over the long term, particularly with HLA-matched related donors. However, the use of alternative donors, such as haploidentical, mismatched, or matched unrelated donors, has previously been limited due to increased transplant-related morbidity, particularly graft-versus-host disease (GVHD). HCTs have therefore been limited to young recipients and those with HLA-matched related donors, creating significant disparity for older adults and those who lack matched donor options. Nevertheless, more recent advances in HCT, such as posttransplant cyclophosphamide for GVHD prophylaxis, have led to improved outcomes of HCT with alternative donors; however, alternative donor HCT remains underused as up-front therapy, in part because of limited multicenter trial data. This review discusses current SAA treatment approaches, including both IST and HCT, and highlights remaining gaps. It also discusses how ongoing clinical trials such as CureAA and TransIT could help address these gaps. Furthermore, we discuss the importance of stakeholder engagement and implementation science in the integration of research-based evidence into clinical practice. Bridging these gaps is necessary for achieving equitable access for patients historically excluded from frontline HCT, including older adults and racially or ethnically diverse populations.
First Page
4448
Last Page
4457
DOI
10.1182/bloodadvances.2024015405
Publication Date
9-9-2025
Recommended Citation
Bhatt NS, Borogovac A, Efebera YA, DeSalvo A, Devine SM, Foley A, Greco-Stewart V, Hamilton BK, Heuer M, Molfenter T, Plastaras JP, Ragon BK, Wall SA, Broglie L, Juckett MB, Khera N, Horowitz MM, DeZern AE. Up-front alternative donor HCT in severe aplastic anemia: gaps and opportunities to translate evidence into practice. Blood Adv. 2025 Sep 9;9(17):4448-4457. doi: 10.1182/bloodadvances.2024015405. PMID: 40554428; PMCID: PMC12410533.