title: Haploidentical Transplantation Without In Vitro T-Cell Depletion Results in Outcomes Equivalent to Those of Contemporaneous Matched Sibling and Unrelated Donor Transplantation for Acute Leukemia.
abstract: The aim of the study is to determine whether HLA-haploidentical-related donor (HRD) transplant can achieve equivalent outcomes and have stronger GVL compared to HLA-matched sibling donor (MSD) and HLA-matched unrelated donor (MUD) transplants. A total of 355 consecutive patients with acute leukemia undergoing allogeneic transplant at our single institute between March 2008 and March 2014 were enrolled in this retrospective investigation. Of the 355 patients, 96 cases received HRD, 153 MSD, and 106 MUD transplants. HRD transplant was associated with higher incidences of grade II to IV aGVHD (40.6%) compared with MSD (23.5%, P = 0.002) and MUD transplants (34.0%, P = 0.049), whereas incidences of grade III to IV aGVHD (11.4%, 7.8%, 10.5%, respectively; P = 0.590) and cGVHD (29.5%, 24.0%, 29.5%, respectively; P = 0.538) did not differ among 3 groups. Five-year relapse rates were 19.2%, 26.8%, and 23.0% in 3 groups, respectively (P = 0.419). However, of 206 high-risk patients, the relapse rate in HRD transplant was lower than in MSD transplant (23.8% vs 41.9%, P = 0.026). Multivariate analysis showed that HRD had beneficial impact on relapse (for MSD: P = 0.006). Five-year transplant-related mortality was lower in MSD transplant compared with those in HRD (17.3% vs 26.4%, P = 0.041) and MUD transplants (17.3% vs 24.1%, P = 0.037). Five-year overall survival were 60.4%, 64.6%, and 61.0%, respectively, in HRD, MSD, and MUD groups (P = 0.371); 5-year disease-free survival were 59.6%, 58.8%, and 54.9%, respectively (P = 0.423). Our results suggest that HRD transplant results in outcomes equivalent to MSD and MUD transplants. HRD might carry a superior GVL effect compared to MSD for high-risk patients.
authors.affiliation: From the Department of Hematology (SY, QF, JS, ZF, YZ, QJ, FH, LX, MD, HZ, HL, Q-FL), Nanfang Hospital, Southern Medical University, Guangzhou, China; and Department of Hematology (SY), Nanhai Hospital, Southern Medical University, Foshan, China.
authors.forename: Sijian
authors.initials: S
authors.lastname: Yu
authors.forename: Qian
authors.initials: Q
authors.lastname: Fan
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Fan
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Qianli
authors.initials: Q
authors.lastname: Jiang
authors.forename: Fen
authors.initials: F
authors.lastname: Huang
authors.forename: Li
authors.initials: L
authors.lastname: Xuan
authors.forename: Min
authors.initials: M
authors.lastname: Dai
authors.forename: Hongsheng
authors.initials: H
authors.lastname: Zhou
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.forename: Qi-Fa
authors.initials: QF
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D020544:Graft vs Leukemia Effect; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D015456:Leukemia, Biphenotypic, Acute / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D014019:Tissue Donors / Q000145:classification