Blood Res  
Similar transplant outcomes between haploidentical and unrelated donors after reduced-intensity conditioning with busulfan, fludarabine, and anti-thymocyte globulin in patients with acute leukemia or myelodysplastic syndrome
Mihong Choi1, Ja Yoon Heo1, Dong-Yeop Shin1,2,3, Ji Yun Lee4, Youngil Koh1,2,3, Junshik Hong1,2,3, Inho Kim1,3, Sung-Soo Yoon1,2,3, Jeong-Ok Lee4, Soo-Mee Bang4
1Division of Hematology and Medical Oncology, Department of Internal Medicine, 2Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, 3Cancer Research Institute, Seoul National University College of Medicine, Seoul, 4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Correspondence to: Dong-Yeop Shin, M.D., Ph.D.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 101 Daehag-ro, Jongno-gu, Seoul 03080, Korea
E-mail: stephano.dyshin@gmail.com
Published online: February 24, 2020.
© The Korean Journal of Hematology. All rights reserved.

Abstract
Background: Although T-cell-replete hematopoietic cell transplantation (HCT) from haploidentical donors (HIDs) using anti-thymocyte globulin (ATG) has shown promising outcomes, previous studies often adopted heterogenous graft sources and conditioning.
Methods: We retrospectively compared HCT outcomes from 62 HIDs, 36 partially-matched unrelated donors (PUDs), and 55 matched unrelated donors (MUDs) in patients with acute leukemia or myelodysplastic syndrome using the same graft source of peripheral blood and a reduced intensity conditioning of busulfan, fludarabine, and ATG.
Results: The estimates of 3-yr disease-free survival (DFS) and overall survival (OS) rates were not significantly different among the MUD, HID, and PUD groups, at 46%, 41% and 36% for the DFS rate (P=0.844), and 55%, 45%, and 45% for the OS rate (P=0.802), respectively. Cumulative incidence of relapse and non-relapse mortality at 3 yr was similar among different donor types. Subsequent multivariate analyses showed that the sex of the patient (male) and a high/very high disease risk index were independently associated with poorer DFS and OS, while the donor type was not.
Conclusion: T-cell replete HCT from HIDs, using an ATG-containing reduced intensity conditioning regimen, may be a reasonable option in the absence of matched related donors in patients with acute leukemia or myelodysplastic syndrome.
Keywords: Haploidentical stem cell transplantation, HLA-matched unrelated donor, Reduced-intensity conditioning, Anti-thymocyte globulin


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