Haploidentical transplantation has a superior graft-versus-leukemia effect than HLA-matched sibling transplantation for Ph- high-risk B-cell acute lymphoblastic leukemia.
Chin Med J (Engl)
; 135(8): 930-939, 2022 Apr 20.
Article
em En
| MEDLINE
| ID: mdl-35467818
ABSTRACT
BACKGROUND:
Compared with human leukocyte antigen (HLA)-matched sibling donor (MSD) transplantation, it remains unclear whether haploidentical donor (HID) transplantation has a superior graft-versus-leukemia (GVL) effect for Philadelphia-negative (Ph-) high-risk B-cell acute lymphoblastic leukemia (B-ALL). This study aimed to compare the GVL effect between HID and MSD transplantation for Ph- high-risk B-ALL.METHODS:
This study population came from two prospective multicenter trials (NCT01883180, NCT02673008). Immunosuppressant withdrawal and prophylactic or pre-emptive donor lymphocyte infusion (DLI) were administered in patients without active graft-versus-host disease (GVHD) to prevent relapse. All patients with measurable residual disease (MRD) positivity posttransplantation (post-MRD+) or non-remission (NR) pre-transplantation received prophylactic/pre-emptive interventions. The primary endpoint was the incidence of post-MRD+.RESULTS:
A total of 335 patients with Ph- high-risk B-ALL were enrolled, including 145 and 190, respectively, in the HID and MSD groups. The 3-year cumulative incidence of post-MRD+ was 27.2% (95% confidence interval [CI] 20.2%-34.7%) and 42.6% (35.5%-49.6%) in the HID and MSD groups (Pâ=â0.003), respectively. A total of 156 patients received DLI, including 60 (41.4%) and 96 (50.5%), respectively, in the HID and MSD groups (Pâ=â0.096). The 3-year cumulative incidence of relapse was 18.6% (95% CI 12.7%-25.4%) and 25.9% (19.9%-32.3%; Pâ=â0.116) in the two groups, respectively. The 3-year overall survival (OS) was 67.4% (95% CI 59.1%-74.4%) and 61.6% (54.2%-68.1%; Pâ=â0.382), leukemia-free survival (LFS) was 63.4% (95% CI 55.0%-70.7%) and 58.2% (50.8%-64.9%; Pâ=â0.429), and GVHD-free/relapse-free survival (GRFS) was 51.7% (95% CI 43.3%-59.5%) and 37.8% (30.9%-44.6%; Pâ=â0.041), respectively, in the HID and MSD groups.CONCLUSION:
HID transplantation has a lower incidence of post-MRD+ than MSD transplantation, suggesting that HID transplantation might have a superior GVL effect than MSD transplantation for Ph- high-risk B-ALL patients. TRIAL REGISTRATION ClinicalTrials.gov NCT01883180, NCT02673008.
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Base de dados:
MEDLINE
Assunto principal:
Leucemia-Linfoma Linfoblástico de Células Precursoras
/
Transplante Haploidêntico
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Doença Enxerto-Hospedeiro
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article