Chronic graft-versus-host disease after haploidentical transplantation in aplastic anemia: clinical characteristics, risk factors, and survival outcomes.

To investigate the clinical characteristics, risk factors, and impacts of chronic graft-versus-host disease (cGvHD) on survival outcomes in patients with severe aplastic anemia (SAA) following haploidentical hematopoietic stem cell transplantation (haplo-HSCT), a cohort of 530 patients was analyzed. The findings revealed that 156 patients developed cGvHD, with a 5-year cumulative incidence of 29.6% (72.4% mild, 17.9% moderate, 9.6% severe). Multivariate analysis identified patient age ≥18 years (hazard ratio [HR] = 1.38, P = 0.044) and a history of grade II-IV acute GvHD (HR = 1.69, P = 0.002) as independent risk factors for cGvHD development. For severe cGvHD, risk factors included previous antithymocyte globulin treatment (HR = 2.99, P = 0.035) and a history of grade III-IV acute GvHD (HR = 4.37, P = 0.010). No significant difference in OS was observed between cGvHD and non-cGvHD groups, but the 5-year OS rate was significantly lower in patients with moderate to severe cGvHD compared to those without the condition (84.3% vs. 95.1%, P = 0.006). Among patients with cGvHD, patients with severe cGvHD had significantly lower 5-year OS (80.0%) than those with mild (97.3%) or moderate (96.4%) cGvHD (P = 0.007). These findings contribute to understanding cGvHD in SAA patients after haplo-HSCT, aiding in personalized management to improve outcomes.