title: Haploidentical/mismatched hematopoietic stem cell transplantation without in vitro T cell depletion for T cell acute lymphoblastic leukemia.
abstract: The outcome of T cell acute lymphoblastic leukemia (T-ALL) is poorly understood. Allogeneic hematopoietic stem cell transplantation (HSCT) remains 1 of the best options to cure T-ALL. However, many patients cannot find an HLA-matched donor. Our institute established a new protocol for haplo-identical HSCT. Busulfan, cyclophosphamide, cytosine arabinoside, and methyl CCNU plus antithymocyte globulin was used for conditioning therapy. Seventy-two patients diagnosed with T-ALL underwent transplantation from haploidentical donor family members. The incidence rates of grades II to IV acute graft-versus-host disease (aGVHD) and of grades III and IV aGVHD were 49% ± 12% and 19% ± 12%, respectively. The cumulative incidence rate for chronic GVHD (cGVHD) at 2 years after HSCT was 41% ± 12%. After a median follow-up of 12 months, 15 patients had relapsed, 14 died from relapse, and 41 patients were still alive without disease recurrence. The probability of leukemia-free survival (LFS) was 44.2% ± 7.4% at 3 years. Patients transplanted during their first complete remission (CR1) had a lower relapse rate (18.8% versus 37.5%, P = .049, with a relative risk [RR] = 0.247, P = .007), a lower nonrelapse mortality (NRM) rate (16.6% versus 50.0%, P = .046, with an RR = 0.279, P = .024), and better LFS (54.8% versus 12.5%, P = .001, with an RR = 0.315, P = .004) compared with patients transplanted beyond CR1. This study confirmed that haploidentical/mismatched HSCT could be an alternative treatment choice for T-ALL.
authors.affiliation: Peking University, People's Hospital, Peking University Institute of Hematology, Beijing, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Dai-Hong
authors.initials: DH
authors.lastname: Liu
authors.forename: Lan-Ping
authors.initials: LP
authors.lastname: Xu
authors.forename: Kai-Yan
authors.initials: KY
authors.lastname: Liu
authors.forename: Huan
authors.initials: H
authors.lastname: Chen
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Zhang
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D006680:HLA Antigens / Q000276:immunology*; D006239:Haplotypes / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006648:Histocompatibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012720:Severity of Illness Index; D019172:Transplantation Conditioning
chemical_list: D000970:Antineoplastic Agents; D006680:HLA Antigens