1. Conditioning including antithymocyte globulin followed by unmanipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparable outcomes with HLA-identical sibling transplantation
- Author
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Dao Pei Lu, Huan Chen, Mei-Jie Zhang, Chen Yh, Lan ping Xu, Kai Yan Liu, Lujia Dong, Yao Chen Zhang, Xiao-Jun Huang, Dan Li, Tong Wu, Han Yun Ren, Dai Hong Liu, Wei Han, and Zhi-Yong Gao
- Subjects
Male ,Transplantation Conditioning ,Graft vs Host Disease ,Severity of Illness Index ,Biochemistry ,Gastroenterology ,Cohort Studies ,HLA Antigens ,Recurrence ,Antineoplastic Combined Chemotherapy Protocols ,Living Donors ,Treatment Failure ,Child ,Bone Marrow Transplantation ,Acute leukemia ,Leukemia ,Incidence ,Incidence (epidemiology) ,Hematopoietic Stem Cell Transplantation ,Hematology ,Middle Aged ,medicine.anatomical_structure ,Child, Preschool ,Histocompatibility ,Acute Disease ,Female ,Immunosuppressive Agents ,Adult ,medicine.medical_specialty ,Adolescent ,Immunology ,Internal medicine ,Severity of illness ,medicine ,Humans ,Transplantation, Homologous ,Busulfan ,Cyclophosphamide ,Antilymphocyte Serum ,Neoplasm Staging ,business.industry ,Infant, Newborn ,Infant ,Cell Biology ,medicine.disease ,Surgery ,Transplantation ,Relative risk ,Chronic Disease ,Bone marrow ,business - Abstract
The outcomes of 293 patients with leukemia undergoing HLA-identical sibling (n = 158) or related HLA-mismatched (n = 135) hematopoietic cell transplantation (HCT) performed during the same time period were compared. Patients received BUCY2 in HLA-identical sibling HCT or BUCY2 + ATG in mismatched HCT as conditioning regimens, followed by unmanipulated marrow and/or peripheral blood (PB) transplantation. All patients achieved full engraftment. The cumulative incidences of grades II to IV acute graft-versus-host disease (aGVHD) in the matched and mismatched cohorts were 32% (CI, 25%-39%) versus 40% (CI, 32%-48%, P = .13), respectively, with the relative risk (RR) = 0.64 (95% CI, 0.43-0.94), P = .02. The incidence of chronic GVHD did not differ significantly between the cohorts (P = .97). Two-year incidences of treatment-related mortality and relapse for matched versus mismatched were 14% (range, 9%-20%) versus 22% (range, 15%-29%) with P = .10 and 13% (range, 8%-19%) versus 18% (range, 10%-27%) with P = .40, respectively. Two-year adjusted leukemia-free survival (LFS) and overall survival were 71% (range, 63%-78%) versus 64% (range, 54%-73%) with P = .27 and 72% (range, 64%-79%) versus 71% (range, 62%-77%) with P = .72, respectively. Multivariate analyses showed that only advanced disease stage and a diagnosis of acute leukemia had increased risk of relapse, treatment failure, and overall mortality. In summary, HCT performed with related HLA-mismatched donors is a feasible approach with acceptable outcomes.
- Published
- 2006
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