Idarubicin-intensified haploidentical HSCT with GvHD prophylaxis of ATG and basiliximab provides comparable results to sibling donors in high-risk acute leukemia.

Abstract

We designed a novel haploidentical hematopoietic stem cell transplantation (haplo-HSCT) system using idarubicin (IDA) intensified conditioning regimens and combination of antithymocyte globulin and basiliximab for GvHD prophylaxis. The outcomes of 110 high-risk acute leukemia patients undergoing haplo-HSCT were compared with 69 contemporaneous high-risk patients receiving HLA-matched sibling transplantation using uniform IDA-intensified regimens. The relapse incidence of haplo-HSCT was 23.4%, and 3-year overall survival (OS) and disease-free survival (DFS) achieved 62.9%, 59.1%, respectively. The cumulative incidences of II-IV and III-IV aGvHD were 28.6 and 14.3%, while limited and extensive cGvHD were 19.4, 13.8%. All these results were equivalent to those of concurrent identical sibling transplantation. Three-year OS and DFS for patients in advance stage reached 48.5, 47.3%. Furthermore, the relapse, 3-year OS of positive minimal residual disease (MRD) patients did not differ from negative MRD patients (18.9% vs 11.5%, 63.6% vs 69.6%), indicating our intensified haplo-HSCT technique could circumvent the dismal prognosis of MRD. These data provide reinforcing evidence that our haplo-HSCT system could dramatically improve the survival of high-risk acute leukemia with low relapse and acceptable transplantation-related mortality, and might be a promising therapeutic option for high-risk patients.

• Authors: R Zhang, W Shi, H-F Wang, Y You, Z-D Zhong, W-M Li, C Zhang, X Lu, Y-D Wang, P Zheng, J Fang, M Hong, Q-L Wu, L-H Xia
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 52 Issue 9 Pg. 1253-1260 (Sep 2017) ISSN: 1476-5365 [Electronic] England
• PMID: 28581464 (Publication Type: Journal Article)

Chemical References

• Antibiotics, Antineoplastic
• Antibodies, Monoclonal
• Antilymphocyte Serum
• Recombinant Fusion Proteins
• Basiliximab
• Idarubicin

Topics

• Acute Disease
• Adolescent
• Adult
• Antibiotics, Antineoplastic (pharmacology, therapeutic use)
• Antibodies, Monoclonal (pharmacology, therapeutic use)
• Antilymphocyte Serum (pharmacology, therapeutic use)
• Basiliximab
• Child
• Female
• Graft vs Host Disease (prevention & control)
• Hematopoietic Stem Cell Transplantation (methods)
• Humans
• Idarubicin (pharmacology, therapeutic use)
• Male
• Middle Aged
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (drug therapy, pathology, therapy)
• Recombinant Fusion Proteins (pharmacology, therapeutic use)
• Siblings
• Tissue Donors
• Transplantation Conditioning (methods)
• Young Adult