Haploidentical Hematopoietic Stem Cell Transplants Compared with Matched Sibling and Unrelated Transplants for Adults with standard risk Acute Lymphoblastic Leukemia in First Complete Remission


The aim of the study is to investigate whether HLA haploidentical donor (HID) transplants might achieve equivalent outcomes for adults with standard-risk acute lymphoblastic leukemia (ALL) in first complete remission (CR1) compared to HLA-matched sibling donor (MSD) and HLA-matched unrelated donor (MUD) transplants. A total of 348 consecutive adult patients with standard-risk ALL in CR1 undergoing allogeneic transplants at our multi-centre between February 2010 and December 2014 were enrolled in this retrospective investigation, including 127 HID, 144 MSD and 77 MUD transplants. The cumulative incidences of Grades II-IV acute graft-versus-host disease (aGVHD) by day +100 post-transplants were 38.1%, 24.1% and 38.8%, respectively, in HID, MSD and MUD transplants (HID vs MSD, P = 0.028; MSD vs MUD, P= 0.050; HID vs MUD, P = 0.991), whereas incidences of aGVHD Grade -IV by day +100 were not different (11.9%, 8.9%, 13.6% respectively, P= 0.657), and 3-year incidences of chronic GVHD were 45.2%, 40.7%, and 45.6% respectively (P = 0.713).  Five-year cumulative transplant related mortality were 16.9%, 12.5% and 20.1% in HID, MSD and MUD transplants respectively (P = 0.175), 5-year overall survival (OS) and disease-free survival (DFS) post-transplants were not different among three groups (OS: 70.1%, 73.7% and 69.8%, P= 0.525; DFS: 68.7%, 67.3% and 63.5%, P= 0.595). Furthermore, the 3-year GRFS rates were not different among 3 groups (50.8%, 54.9% and 52.2% respectively, p = 0.890).

our results indicate that outcomes of HID transplants are equivalent to those of MSD and MUD transplantsand HID transplant is a valid alternative choice for standard-risk adult ALL in CR1 who lack a matched donor.


Posted by: Lijie Han, attending doctor, Department of Hematology, Nanfang Hospital, Southern Medical University, China (11-Dec-2016)