title: Comparable outcomes of partially matched related and matched related allogeneic hematopoietic cell transplantation following reduced-intensity conditioning in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia.
abstract: Reports from multiple centers have shown that reduced-intensity allogeneic hematopoietic cell transplantation (RIC-HCT) is able to benefit some adult patients suffering from Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL). However, the relationship between donor cell source and outcome of RIC-HCT in (Ph-)ALL patients has not been elucidated. In this study, we present the outcome of 57 (Ph-)ALL patients treated with reduced-intensity conditioning (RIC) followed by HCT from HLA-matched related (MRD, n = 34) or HLA partially matched related (PMRD, n = 23) donors from a multicenter cohort. Neutrophil recovery at day 100 occurred in 91.3 % of the PMRD group and 97.1 % of the MRD group (P = 0.84). One hundred days after treatment, the cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) was 30.4 % (95 % confidence interval [CI], 13.0-53.0 %) in patients who received PMRD grafts, and 27.3 % (95 % CI, 15.0-48.0 %) for those who received MRD grafts (P = 0.76). The cumulative risk of developing chronic GVHD was 59.4 % (95 % CI, 31.0-72.0 %) in the MRD group and 23.4 % (95 % CI, 4.0-43.0 %) in the PMRD group (P = 0.03). The cumulative incidence of relapse in patients who received PMRD grafts was 18.8 % (95 % CI, 3.0-34.0 %), while for those who received MRD grafts it was 37.2 % (95 % CI, 15.0-48.0 %) (P = 0.32). Overall treatment-related mortality was 41.6 % (95 % CI, 20.0-62.0 %) in the PMRD group and 19.9 % (95 % CI, 7.0-35.0 %) in the MRD group (P = 0.08). Relapse was the most common cause of mortality in the MRD group, while infection contributed to the majority of deaths in the PMRD group. The 3-year probability of disease-free survival did not differ significantly between the two groups (55.5 % for the PMRD group vs. 48.4 % for the MRD group; P = 0.81). These data strongly suggest that RIC-HCT performed with PMRD may represent an alternative treatment option for adult patients with (Ph-)ALL.
authors: Department of Hematology, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors: Xiaojin
authors: X
authors: Wu
authors: Guangsheng
authors: G
authors: He
authors: Yihua
authors: Y
authors: Fa
authors: Xiao
authors: X
authors: Ma
authors: Depei
authors: D
authors: Wu
authors: Huisheng
authors: H
authors: Ai
authors: Xiaojun
authors: X
authors: Huang
authors: Yue
authors: Y
authors: Han
authors: Yang
authors: Y
authors: Xu
authors: Aining
authors: A
authors: Sun
authors: Qian
authors: Q
authors: Wu
authors: Xiaowen
authors: X
authors: Tang
authors: Zhengzheng
authors: Z
authors: Fu
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics* / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
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