获得性严重再生障碍性贫血的免疫抑制治疗可改善全血细胞减少症，但存在复发 (40%) 和克隆进化为髓系肿瘤 (15%) 的显着风险，特别是在 40 岁以上的患者中。然而，目前针对新诊断的严重再生障碍性贫血患者的指南40岁以上建议免疫抑制治疗而不是治愈性同种异体干细胞移植。前期同种异体干细胞移植仅限于不仅年轻而且有匹配的兄弟姐妹捐赠者的罕见患者。本文将讨论有关前期替代供体造血细胞移植最新进展的改变实践的数据，这些数据可能重写当前的治疗算法。版权所有 2024，Wirk。

Immunosuppressive therapy for acquired severe aplastic anemia improves pancytopenia but has a significant risk of relapse (40%) and clonal evolution to myeloid neoplasms (15%), especially in patients older than 40. Yet, current guidelines for newly diagnosed severe aplastic anemia patients over the age of 40 recommend immunosuppressive therapy instead of curative allogeneic stem cell transplantation. Upfront allogeneic stem cell transplants are restricted to the rare patient who is not only young but also has a matched sibling donor. This article will discuss practice-changing data on the recent advances in upfront alternative donor hematopoietic cell transplants that could rewrite current treatment algorithms.Copyright 2024, Wirk.