Superior graft-versus-leukemia effect associated with transplantation of haploidentical compared with HLA-identical sibling donor grafts for high-risk acute leukemia: an historic comparison.
The outcomes of an historic comparison of 117 consecutive, high-risk, acute leukemia patients undergoing hematopoietic stem cell transplantation (HSCT) from HLA-mismatched/haploidentical donors (HID, n = 81) or HLA-identical sibling donors (ISD, n = 36) without the use of in vitro T cell depletion (TCD), between the period of January 2005 and April 2009 were compared. Full engraftment was achieved in 98% of patients in the HID group and 97% in the ISD group. The cumulative incidences of grades II-IV acute graft-versus-host disease (aGVHD) in the HID and ISD cohorts were 49% and 24%, respectively (P = .014) with a relative risk (RR) of 2.99 (1.25-7.21) (P = .014). The incidence of chronic GVHD (cGVHD) did not differ significantly between the 2 cohorts. The 2-year cumulative incidence of relapse was significantly lower in HID (26%) than in ISD patients (49%) (P = .008). The 2-year cumulative incidence of nonrelapse mortality (NRM) was comparable in recipients of HID (34%) and ISD grafts (38%) (P = .85). The 3-year probability of overall survival (OS) was higher in HID patients (42%) than in ISD (20%) (P = .048) patients. Our comparisons suggest that HID transplants can achieve a stronger graft-versus-leukemia (GVL) effect than ISD for high-risk acute leukemia patients.
Wang
Yu
Y
Peking University People's Hospital, Institute of Hematology, Beijing, People's Republic of China.
Liu
Dai-Hong
DH
Xu
Lan-Ping
LP
Liu
Kai-Yan
KY
Chen
Huan
H
Chen
Yu-Hong
YH
Han
Wei
W
Shi
Hong-Xia
HX
Huang
Xiao-Jun
XJ
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002681:China; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D006680:HLA Antigens / Q000276:immunology*; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention; D035781:Siblings; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning
D000970:Antineoplastic Agents; D006680:HLA Antigens