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Blood Res 2020; 55(1):
Published online March 31, 2020
https://doi.org/10.5045/br.2020.55.1.27
© The Korean Society of Hematology
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
Correspondence to : Dong-Yeop Shin, M.D., Ph.D.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
E-mail: stephano.dyshin@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 multivariable 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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Original Article
Blood Res 2020; 55(1): 27-34
Published online March 31, 2020 https://doi.org/10.5045/br.2020.55.1.27
Copyright © The Korean Society of Hematology.
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 College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
E-mail: stephano.dyshin@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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 multivariable 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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Abbreviations: HID, haploidentical familial donors; MUD, matched unrelated donors; PUD, partially matched unrelated donors.
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Patients and treatment characteristics. .a)
P -value by χ2 test for categorical variables and one-way ANOVA for continuous variables..Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; ATG, antithymocyte globulin; CNI, calcineurin inhibitor; HCT, hematopoietic cell transplantation; HCT-CI, hematopoietic cell transplantation comorbidity index; HID, haploidentical familial donors; MDS, myelodysplastic syndrome; MUD, matched unrelated donors; PUD, partially-matched unrelated donors..
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Univariable analyses for survival. .Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; ATG, antithymocyte globulin; DFS, disease-free survival; GRFS, graft-vs.-host disease-free, relapse-free survival; HCT-CI, hematopoietic cell transplantation comorbidity index; HID, haploidentical familial donors; MDS, myelodysplastic syndrome; MUD, matched unrelated donors; OS, overall survival; PUD, partially-matched unrelated donors..
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Multivariable analyses for survival. .Abbreviations: DFS, disease-free survival; GRFS, graft-vs.-host disease-free, relapse-free survival; HCT-CI, hematopoietic cell transplantation comorbidity index; HID, haploidentical familial donors; MUD, matched unrelated donors; OS, overall survival; PUD, partially matchedunrelated donors..
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