T-cell-replete haploidentical HSCT with low-dose anti-T-lymphocyte globulin compared with matched sibling HSCT and unrelated HSCT

Abstract

We developed an approach of T-cell-replete haploidentical hematopoietic stem cell transplantation (HSCT) with low-dose anti-T-lymphocyte globulin and prospectively compared outcomes of all contemporaneous T-cell-replete HSCT performed at our center using matched sibling donors (MSDs), unrelated donors (URDs), and haploidentical related donors (HRDs). From 2008 to 2013, 90 patients underwent MSD-HSCT, 116 underwent URD-HSCT, and 99 underwent HRD-HSCT. HRDs were associated with higher incidences of grades 2 to 4 (42.4%) and severe acute graft-versus-host disease (17.2%) and nonrelapse mortality (30.5%), compared with MSDs (15.6%, 5.6%, and 4.7%, respectively; P < .05), but were similar to URDs, even fully 10/10 HLA-matched URDs. For high-risk patients, a superior graft-versus-leukemia effect was observed in HRD-HSCT, with 5-year relapse rates of 15.4% in HRD-HSCT, 28.2% in URD-HSCT (P = .07), and 49.9% in MSD-HSCT (P = .002). Furthermore, 5-year disease-free survival rates were not significantly different for patients undergoing transplantation using 3 types of donors, with 63.6%, 58.4%, and 58.3% for MSD, URD, and HRD transplantation, respectively (P = .574). Our data indicate that outcomes after HSCT from suitably matched URDs and HRDs with low-dose anti-T-lymphocyte globulin are similar and that HRD improves outcomes of patients with high-risk leukemia. This trial was registered at www.chictr.org (Chinese Clinical Trial Registry) as #ChiCTR-OCH-12002490.

© 2014 by The American Society of Hematology.

Figures

Figure 1

Cumulative incidences of grades 2 to 4 and 3 to 4 aGVHD stratified according to the donor types. (A) Grades 2 to 4 aGVHD. (B) Grades 3 to 4 aGVHD. (C) Grades 2 to 4 aGVHD controlling for patients received stem cells from a fully 10/10 HLA -matched URD. (D) Grades 3 to 4 aGVHD controlling for patients received stem cells from a fully 10/10 HLA -matched URD. (Analyzed by the competing risk method.)

Figure 2

Cumulative incidence of relapse at 5 years after transplantation stratified according to the donor types. (A) All patients. (B) Controlling for high-risk patients. (Analyzed by the competing risk method.)

Figure 3

Cumulative incidence of NRM stratified according to the donor types. (A) All patients. (B) Controlling for patients received stem cells from a fully 10/10 HLA -matched URD. (Analyzed by Kaplan-Meier method.)

Figure 4

OS and DFS at 5 years after transplantation stratified according to the donor types. (A) OS. (B) DFS. (Analyzed by Kaplan-Meier method.)