title: HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: improved outcomes in patients in accelerated phase and blast crisis phase.
abstract: BACKGROUND
  Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only proven curative therapy for chronic myeloid leukemia (CML), but lack of human leukocyte antigen (HLA)-matched sibling or unrelated donors has restricted its application. Recently, we developed an effective method for haploidentical allo-HSCT achieving comparable outcomes to HLA-identical transplantation.
  
  
  OBJECTIVE
  To evaluate the outcomes of CML patients who underwent haploidentical allo-HSCT.
  
  
  METHODS
  Ninety-three patients were treated with a modified busulfan (BU)/cyclophosphamide (CY) 2 regimen, including antithymocyte globulin followed by unmanipulated blood and marrow transplantation.
  
  
  RESULTS
  Our data showed that the cumulative incidence of acute graft-versus-host disease (GVHD) was 64.52%, and grade III-IV was 26.45%, 61.79% had chronic GVHD, and 28.93% had extensive chronic GVHD. Non-relapse mortality varied at 8.72% (100 days), 20.72% (1 year) and 20.72% (2 years). Probability of 1-year and 4-year leukemia-free survival was similar in chronic phase (CP) 1, CP2/CR2, accelerated phase, and blast crisis patients. Probability of 4-year overall survival varied as 76.5% (CP1), 85.7% (CP2/CR2), 73.3% (accelerated phase), and 61.5% (blast crisis). Multivariate analysis indicated that factors affecting transplantation outcomes were HLA-B+DR mismatches versus others for II-III acute GVHD and III-IV acute GVHD, the stage of disease at transplantation for relapse, and the time from diagnosis to transplantation for leukemia-free survival, overall survival, and transplantation-related mortality. In our protocol, survival of HSCT for advanced CML was similar to stable stage.
  
  
  CONCLUSIONS
  For patients lacking an HLA-identical related donor, haploidentical relatives are alternative HSCT donors.
authors.affiliation: Peking University Institute of Hematology, People's Hospital, Beijing, China. xjhrm@medmail.com.cn
authors.forename: Huang
authors.initials: H
authors.lastname: Xiao-Jun
authors.forename: Xu
authors.initials: X
authors.lastname: Lan-Ping
authors.forename: Liu
authors.initials: L
authors.lastname: Kai-Yan
authors.forename: Liu
authors.initials: L
authors.lastname: Dai-Hong
authors.forename: Chen
authors.initials: C
authors.lastname: Huan
authors.forename: Han
authors.initials: H
authors.lastname: Wei
authors.forename: Chen
authors.initials: C
authors.lastname: Yu-Hong
authors.forename: Wang
authors.initials: W
authors.lastname: Jing-Zhi
authors.forename: Chen
authors.initials: C
authors.lastname: Yao
authors.forename: Zhang
authors.initials: Z
authors.lastname: Xiao-Hui
authors.forename: Shi
authors.initials: S
authors.lastname: Hong-Xia
authors.forename: Lu
authors.initials: L
authors.lastname: Dao-Pei
mesh_terms: D000293:Adolescent; D000328:Adult; D001752:Blast Crisis / Q000628:therapy*; D002648:Child; D033001:Directed Tissue Donation; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult