title: The long-term outcome of reduced-intensity allogeneic stem cell transplantation from a matched related or unrelated donor, or haploidentical family donor in patients with leukemia: a retrospective analysis of data from the China RIC Cooperative Group.
abstract: This study compared 6-year follow-up data from patients undergoing reduced-intensity conditioning (RIC) transplantation with an HLA-matched related donor (MRD), an HLA-matched unrelated donor (MUD), or an HLA-haploidentical donor (HID) for leukemia. Four hundred and twenty-seven patients from the China RIC Cooperative Group were enrolled, including 301 in the MRD, 79 in the HID, and 47 in the MUD groups. The conditioning regimen involved fludarabine combined with anti-lymphocyte globulin and cyclophosphamide. Graft-versus-host disease (GVHD) prophylaxis was administered using cyclosporin A (CsA) and mycophenolate mofetil (MMF). Four hundred and nineteen patients achieved stable donor chimerism. The incidence of stage II-IV acute GVHD in the HID group was 44.3 %, significantly higher than that in the MRD (23.6 %) and MUD (19.1 %) groups. The 1-year transplantation-related mortality (TRM) rates were 44.3, 17.6, and 21.3, respectively. Event-free survival (EFS) at 6 years in the HID group was 36.7 %, significantly lower than that of the MRD and MUD groups (59.1 and 66.0 %, P < 0.001 and P = 0.001, respectively). For advanced leukemia, the relapse rate of the HID group was 18.5 %, lower than that of the MRD group (37.5 %, P = 0.05), but the EFS at 6 years was 31.7 and 30.4 % (P > 0.05), respectively. RIC transplantation with MRD and MUD had similar outcome in leukemia which is better than that with HID. RIC transplantation with HID had lower relapsed with higher TRM and GVHD rate, particularly in advanced leukemias. RIC transplantation with MRD and MUD had similar outcomes in leukemia and they were better than those with HID. RIC transplantation with HID had a lower relapse rate but higher TRM and GVHD rates, particularly in cases of advanced leukemia.
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.forename: Chang-Lin
authors.initials: CL
authors.lastname: Yu
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.lastname: Zheng-Dong
authors.affiliation: Second Hospital of Shanxi Medical University, Taiyuan, China.
authors.forename: Zhen-Hua
authors.initials: ZH
authors.lastname: Qiao
authors.affiliation: Chang Hai Hospital of Shanghai Second Military Medical University, Shanghai, China.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Wang
authors.affiliation: Affiliated Hospital of Zhejiang University, Hangzhou, China.
authors.lastname: Huang-He
authors.affiliation: Tang-Du Hospital of Fourth Military Medical University, Xi'an, China.
authors.forename: Ying-Min
authors.initials: YM
authors.lastname: Liang
authors.affiliation: Affiliated Hospital of Suzhou University, Suzhou, China.
authors.forename: De-Pei
authors.initials: DP
authors.lastname: Wu
authors.affiliation: Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
authors.forename: Bao-An
authors.initials: BA
authors.lastname: Chen
authors.affiliation: Lanzhou General Hospital in Lanzhou Military Area Command, Lanzhou, China.
authors.lastname: Bai-Hai
authors.affiliation: 201 Hospital Shenyang, Shenyang, China.
authors.forename: Bao-Fu
authors.initials: BF
authors.lastname: Shi
authors.affiliation: Second Artillery General Hospital, Beijing, China.
authors.forename: Wan-Jun
authors.initials: WJ
authors.lastname: Sun
authors.affiliation: Second Artillery General Hospital, Beijing, China.
authors.forename: Jun-Xiao
authors.initials: JX
authors.lastname: Qiao
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Guo
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.forename: Jian-Hui
authors.initials: JH
authors.lastname: Qiao
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.forename: Qi-Yun
authors.initials: QY
authors.lastname: Sun
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.forename: Kai-Xun
authors.initials: KX
authors.lastname: Hu
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.forename: Ya-Jing
authors.initials: YJ
authors.lastname: Huang
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China.
authors.forename: Hong-Li
authors.initials: HL
authors.lastname: Zuo
authors.affiliation: Department of Hematology and Transplantation, People's Hospital Under Beijing University, Beijing, 100044, China. huangxiaojun@bjmu.edu.cn.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Huang
authors.affiliation: Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China. huishengai@163.com.
authors.forename: Hui-Sheng
authors.initials: HS
authors.lastname: Ai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002681:China / Q000453:epidemiology; D005260:Female; D006239:Haplotypes / Q000235:genetics*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality / Q000639:trends*; D006801:Humans; D007938:Leukemia / Q000235:genetics / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012189:Retrospective Studies; D013223:Statistics as Topic / Q000639:trends; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous / Q000401:mortality / Q000639:trends; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
keywords: Allogeneic stem cell transplantation; China RIC Cooperative Group; Leukemia