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

Abstract:

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)
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