title: HLA-mismatched stem-cell microtransplantation as postremission therapy for acute myeloid leukemia: long-term follow-up.
abstract: OBJECTIVE
  Despite best current therapies, approximately half of patients with acute myeloid leukemia in first complete remission (AML-CR1) with no HLA-identical donors experience relapse. Whether HLA-mismatched stem-cell microtransplantation as a novel postremission therapy in these patients will improve survival and avoid graft-versus-host disease (GVHD) is still unknown.
  
  
  METHODS
  One hundred one patients with AML-CR1 (9 to 65 years old) from four treatment centers received programmed infusions of G-CSF-mobilized HLA-mismatched donor peripheral-blood stem cells after each of three cycles of high-dose cytarabine conditioning without GVHD prophylaxis. Donor chimerism and microchimerism and WT1+CD8+ T cells were analyzed.
  
  
  RESULTS
  The 6-year leukemia-free survival (LFS) and overall survival (OS) rates were 84.4% and 89.5%, respectively, in the low-risk group, which were similar to the rates in the intermediate-risk group (59.2% and 65.2%, respectively; P=.272 and P=.308). The 6-year LFS and OS were 76.4% and 82.1%, respectively, in patients who received a high dose of donor CD3+ T cells (≥1.1×10(8)/kg) in each infusion, which were significantly higher than the LFS and OS in patients who received a lower dose (<1.1×10(8)/kg) of donor CD3+ T cells (49.5% and 55.3%, respectively; P=.091 and P=.041). No GVHD was observed in any of the patients. Donor microchimerism (2 to 1,020 days) was detected in 20 of the 23 female patients who were available for Y chromosome analysis. A significant increase in WT1+CD8+ T cells (from 0.2% to 4.56%) was observed in 33 of 39 patients with positive HLA-A*02:01 antigen by a pentamer analysis.
  
  
  CONCLUSIONS
  Microtransplantation as a postremission therapy may improve outcomes and avoid GVHD in patients with AML-CR1.
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, Dongdajie 8, Beijing 100071, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Guo
authors.forename: Kai-Xun
authors.initials: KX
authors.lastname: Hu
authors.forename: Guang-Xian
authors.initials: GX
authors.lastname: Liu
authors.forename: Chang-Lin
authors.initials: CL
authors.lastname: Yu
authors.forename: Jian-Hui
authors.initials: JH
authors.lastname: Qiao
authors.forename: Qi-Yun
authors.initials: QY
authors.lastname: Sun
authors.forename: Jun-Xiao
authors.initials: JX
authors.lastname: Qiao
authors.forename: Zheng
authors.initials: Z
authors.lastname: Dong
authors.forename: Wan-Jun
authors.initials: WJ
authors.lastname: Sun
authors.forename: Xue-Dong
authors.initials: XD
authors.lastname: Sun
authors.forename: Hong-Li
authors.initials: HL
authors.lastname: Zuo
authors.forename: Qiu-Hong
authors.initials: QH
authors.lastname: Man
authors.forename: Zhi-Qing
authors.initials: ZQ
authors.lastname: Liu
authors.forename: Tie-Qiang
authors.initials: TQ
authors.lastname: Liu
authors.forename: Hong-Xia
authors.initials: HX
authors.lastname: Zhao
authors.forename: Ya-Jing
authors.initials: YJ
authors.lastname: Huang
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.forename: Bing
authors.initials: B
authors.lastname: Liu
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
authors.forename: Xu-Liang
authors.initials: XL
authors.lastname: Shen
authors.forename: Hui-Sheng
authors.initials: HS
authors.lastname: Ai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001781:Blood Component Removal / Q000379:methods; D002648:Child; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage; D015789:HLA-A2 Antigen / Q000276:immunology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000276:immunology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D014019:Tissue Donors; D018183:Transplantation Chimera; D055815:Young Adult
chemical_list: C524866:HLA-A*02 antigen; D015789:HLA-A2 Antigen; D016179:Granulocyte Colony-Stimulating Factor