[Clinical contrasting study on hematopoietic stem cell transplantation from HLA-identical sibling and partially HLA-mismatched related donors].
OBJECTIVE
To explore the therapeutic feasibility of allogeneic hematopoietic stem cell transplantation (allo-HSCT) from partially HLA-mismatched related donors for hematologic diseases.


METHODS
Thirty patients with hematologic diseases received allo-HSCT from 1 - 3 loci mismatched related donors conditioning regimen consisting of ATG (thymoglobulin, total dose of 10 mg/kg, intravenously on - 4 d to - 1 d), and only 5 (18%) of 28 recipients from HLA-identical sibling donors were treated with regimen containing ATG. Donors were given G-CSF prior to hematopoietic stem cell harvest and CsA, short-term MTX and mycophenolate mofetil (MMF) were used for GVHD prophylaxis in both group.


RESULTS
All patients were successfully engrafted. There was no significant difference in the incidence of grade II to IV acute graft-versus-host disease (aGVHD) and grade III to IV aGVHD between the mismatched and matched groups (34% vs 32%, and 13% vs 11%, respectively). 3-year overall survival (OS) and disease-free survival (DFS) in mismatched and matched groups were 57% vs 77% (P = 0.14) and 57% vs 69% (P = 0.28), respectively. Multivariate analysis showed that advanced disease pre-transplant (P = 0.006) and CMV infection (P = 0.04) were risk factors for OS. OS for patients with stable disease in mismatched and matched groups were 87% vs 81% (P = 0.65) respectively, and for those with advanced disease were 21% vs 71% (P = 0.02).


CONCLUSIONS
It is feasible to perform allo-HSCT from 1 -3 loci HLA-mismatched related donors for patients with stable disease who lack HLA-identical sibling donors. Nevertheless, for patients with advanced disease optimized conditioning regimen and intensive supporting therapy should be administered to obtain better clinical outcomes.
Wang
Li-Hong
LH
Department of Hematology, Peking University First Hospital, Beijing 100034, China.
Ren
Han-Yun
HY
Li
Yuan
Y
Qiu
Zhi-Xiang
ZX
Cen
Xi-Nan
XN
Ou
Jin-Ping
JP
Xu
Wei-Lin
WL
Wang
Mang-Ju
MJ
Wang
Ying
Y
Dong
Yu-Jun
YJ
D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D035781:Siblings; D014019:Tissue Donors; D019172:Transplantation Conditioning
D006680:HLA Antigens