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Blood, 15 April 2006, Vol. 107, No. 8, pp. 3065-3073.
Prepublished online as a Blood First Edition Paper on December 27, 2005; DOI 10.1182/blood-2005-05-2146.
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Submitted May 27, 2005
Accepted November 29, 2005
Conditioning including antithymocyte globulin followed by un-manipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparable outcomes to HLA-identical sibling transplantation
Dao-Pei Lu*, Lujia Dong, Tong Wu, Xiao-Jun Huang, Mei-Jie Zhang, Huan Chen, Wei Han, Dai-Hong Liu, Zhi-Yong Gao, Yu-Hong Chen, Lan-Ping Xu, Yao-Chen Zhang, Han-Yun Ren, Dan Li, and Kai-Yan Liu
Department of Hematology, Peking University, Institute of Hematology, People' s Hospital and Beijing Dao- pei Hospital, Beijing, China
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA
* Corresponding author; email: lscm2{at}yahoo.com.
The outcomes of 293 patients with leukemia receiving HLA-identical sibling (n=158) or related HLA-mismatched (n=135) hematopoietic cell transplantation (HCT) performed during the same time period were compared. Patients received BuCy2 in HLA identical sibling HCT or BuCy2+ATG in mismatched HCT as conditioning regimens, followed by un-manipulated marrow and/or peripheral blood (PB) transplantation. All patients achieved full engraftment. The cumulative incidences of II-IV aGVHD in the matched and mismatched cohorts were 32% (CI, 25%-39%) versus 40% (CI, 32%-48%, P=0.13), respectively with the relative risk (RR)=0.64 (95% CI, 0.43-0.94), P=0.02. The incidence of chronic GVHD did not differ significantly between the cohorts (P=0.97). Two year incidences of treatment related mortality and relapse for matched versus mismatched were 14% (9%-20%) vs. 22% (15%-29%) with P=0.10 and 13% (8%-19%) vs. 18% (10%-27%) with P=0.40, respectively. 2 year adjusted leukemia-free survival (LFS) and overall survival were 71% (63%-78%) vs. 64% (54%-73%) with P=0.27 and 72% (64%-79%) vs. 71% (62%-77%) with P=0.72, respectively. Multi-variate analyses showed that only advanced disease stage and a diagnosis of acute leukemia had increased risk of relapse, treatment failure, and overall mortality. In summary, HCT from related HLA mismatched donors is a feasible approach with acceptable outcomes.
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