title: Favorable outcome of haploidentical hematopoietic stem cell transplantation in Philadelphia chromosome-positive acute lymphoblastic leukemia: a multicenter study in Southwest China.
abstract: BACKGROUND
  Since the introduction of tyrosine kinase inhibitors (TKIs) into combination chemotherapy regimens, the majority of newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) patients have achieved complete remission (CR). However, without allogeneic hematopoietic stem cell transplantation (HSCT), long-term outcomes in adults remain unsatisfactory. Indeed, haploidentical HSCT has become a common treatment for adult patients who lack an HLA-matched donor, though limited data are available on the efficacy of haploidentical HSCT in Ph+ ALL patients.
  
  
  METHODS
  We analyzed the clinical outcomes of 82 Ph+ ALL patients who underwent haploidentical HSCT (n = 47) or HLA-matched HSCT (n = 35). Real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed to assess BCR-ABL expression. All of the patients were treated with an imatinib-based regimen before undergoing HSCT. Imatinib treatment was resumed in the patients' posttransplantation following detection of BCR-ABL transcripts.
  
  
  RESULTS
  All of the patients achieved neutrophil and platelet engraftment, with the exception of five patients who died prior to engraftment. Haploidentical HSCT was associated with higher incidences of acute graft-versus-host disease (GVHD) (51.1 vs. 25.7%, p < 0.05) and chronic GVHD (48.9 vs. 25.7%, p < 0.05) compared with HLA-matched HSCT, but there was no difference in the incidence of either grades III-IV acute GVHD or extensive chronic GVHD. The incidence of cytomegalovirus (CMV) infection was significantly higher in the patients treated with haploidentical HSCT than in those treated with HLA-matched HSCT (38.3 vs. 14.3%, p < 0.05). Haploidentical HSCT was associated with a significantly lower relapse rate compared with HLA-matched HSCT (44.8 vs. 19.1%, p < 0.05). There were no differences in non-relapse mortality (NRM), leukemia-free survival (LFS), or overall survival (OS) between the patients who received HLA-matched HSCT and those who underwent haploidentical HSCT.
  
  
  CONCLUSIONS
  Our data indicate that the incidence of NRM after HSCT is similar between the patients who receive HLA-matched donor cells and those who receive haploidentical donor cells and that haploidentical HSCT reduces the relapse rate. Haploidentical HSCT represents an encouraging treatment option for Ph+ ALL patients who lack a suitable HLA-matched donor.
authors.affiliation: Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China. gaotiantiantiger@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China. chzhang2003@hotmail.com.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China. gaolei7765@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Gao
authors.affiliation: Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China. YL_749@foxmail.com.
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Hematology, General Hospital of Chengdu Military Region of PLA, Sichuan, China. suhang1234@hotmail.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Su
authors.affiliation: Department of Hematology, General Hospital of Kunming Military Region of PLA, Yunnan, China. 1204800896@qq.com.
authors.forename: Sanbin
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Hematology, Yunnan Provincial Peoples Hospital, Yunnan, China. libin816904@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Hematology, Second Yunnan Provincial Peoples Hospital, Yunnan, China. ynanblood@yahoo.com.cn.
authors.forename: Tonghua
authors.initials: T
authors.lastname: Yang
authors.affiliation: Department of Hematology, The Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China. yuanzhong1963@126.com.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: Department of Hematology, Xinqiao Hospital, Third Military Medical University, Xinqiao Street, Shangpinba District, Chongqing, 400037, China. zhangxxi@sina.com.
authors.forename: Xi
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010677:Philadelphia Chromosome; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult