Haploidentical transplantation has a superior graft-versus-leukemia effect than HLA-matched sibling transplantation for Ph- high-risk B-cell acute lymphoblastic leukemia  

作　　者：Fan Menglin Wang Yu Lin Ren Lin Tong Huang Fen Fan Zhiping Xu Yajing Yang Ting Xu Na Shi Pengcheng Nie Danian Lin Dongjun Jiang Zujun Wang Shunqing Sun Jing Huang Xiaojun Liu Qifa Xuan Li 

机构地区：[1]Department of Hematology,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong 510515,China [2]Department of Hematology,Peking University People’s Hospital,Peking University Institute of Hematology,Beijing 100044,China [3]Department of Hematology,Xiangya Hospital,Central South University,Changsha,Hunan 110051,China [4]Department of Hematology,Fujian Institute of Hematology,Fujian Medical University Union Hospital,Fuzhou,Fujian 350001,China [5]Department of Hematology,Sun Yat-Sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510130,China [6]Department of Hematology,The Third Affiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510630,China [7]Department of Hematology,Guangzhou General Hospital of Guangzhou Military Command,Guangzhou,Guangdong 510010,China [8]Department of Hematology,Guangzhou First People’s Hospital,Guangzhou,Guangdong 510080,China

出　　处：《Chinese Medical Journal》2022年第8期930-939,共10页中华医学杂志（英文版）

基　　金：National Natural Science Foundation of China(Nos. 81770190, 81970161);National Key Research and Development Program of China(Nos. 2017YFA105500,2017YFA105504);Research and Development Program in Key Areas of Guangdong Province(No. 2019B020236004);Natural Science Foundation of Guangdong Province(No. 2019A1515011924);Project of the Zhujiang Science and Technology Star of Guangzhou City(No. 201806010029);Key Clinical Research Project of Southern Medical University(No. LC2016ZD009)。

摘　　要：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(P = 0.003), respectively. A total of 156 patients received DLI, including 60 (41.4%) and 96 (50.5%), respectively, in the HID and MSD groups (P= 0.096). The 3-year cumulative incidence of relapse was 18.6% (95% CI: 12.7%-25.4%) and 25.9% (19.9%-32.3%;P = 0.116) 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%;P = 0.382), leukemia-free survival (LFS) was 63.4% (95% CI: 55.0%-70.7%) and 58.2% (50.8%-64.9%;P= 0.429), and GVHD-free/relapse-free survival (GRFS) was 51.7% (95% CI: 43.3%-59.5%) and 37.8% (30.9%-44.6%;P= 0.041), 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 transpla

关 键 词：HAPLOIDENTICAL HLA-matched sibling Philadelphia-negative high-risk B-cell acute lymphoblastic leukemia GRAFT-VERSUS-LEUKEMIA TRANSPLANTATION 

分 类 号：R733.71[医药卫生—肿瘤]