title: Haploidentical hematopoietic SCT may be superior to conventional consolidation/maintenance chemotherapy as post-remission therapy for high-risk adult ALL.
abstract: Only 30% of high-risk adult ALL patients in their first complete remission (CR1) are able to receive an HLA-matched sibling stem cell transplant. The role of haploidentical hematopoietic SCT (haplo-HSCT) in post-remission therapy is not well established. Recently, we developed a novel protocol for unmanipulated haploidentical transplantation. In this study, we compared haplo-HSCT with conventional consolidation and maintenance chemotherapy in adult high-risk ALL patients. Between January 2000 and December 2012, 104 patients received conventional chemotherapy and 79 patients received haplo-HSCT. Patients who underwent haplo-HSCT had significantly improved 3-year OS (72.5% vs 26.6%; P<0.001), 3-year disease-free survival (DFS) (63.9% vs 21.1%; P<0.001) and 3-year relapse (18.7% vs 60.5%; P<0.001) rates. The non-relapse mortality (NRM) rate was not different between patients treated with haplo-HSCT vs chemotherapy (19.2% vs 14.4%; P=0.80). In multivariate analysis, the only factor associated with improved OS, better DFS and low risk of relapse was haplo-HSCT. The only factor associated with high NRM was enrollment before 2006. In conclusion, haplo-HSCT may be an option for adults with high-risk ALL in CR1 who do not have an HLA-matched donor.
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
authors.forename: Y-Q
authors.initials: YQ
authors.lastname: Sun
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Jiang
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
authors.forename: L-P
authors.initials: LP
authors.lastname: Xu
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
authors.forename: D-H
authors.initials: DH
authors.lastname: Liu
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
authors.forename: X-H
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
authors.forename: K-Y
authors.initials: KY
authors.lastname: Liu
authors.affiliation: 1] Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China [2] Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China [3] Peking-Tsinghua Center for Life Sciences, Beijing, China.
authors.forename: X-J
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D060830:Consolidation Chemotherapy; D018572:Disease-Free Survival; D005260:Female; D006680:HLA Antigens; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate
chemical_list: D006680:HLA Antigens