Curative Effect Evaluation Of Matched Sibling Donor And Half-matched Sibling Donor Transplantation In Acute Myeloid Leukemia

Research background and purposeAllogeneic hematopoietic stem cell transplantation(allo-HSCT)is currently the only possible cure for acute myeloid leukemia(AML).The main sources of allo-HSCT donors were matched sibling donor(MSD)and haploidentical donor(HID).MSD has long been seen as the best donor,but its position has been shaken in recent years.Multiple studies have shown that the overall efficacy of HID transplantation is as good as that of MSD transplantation,and for some patients,HID transplantation is better than MSD transplantation.However,the prognosis of HID transplantation is not exactly the same among different relatives.Under the condition of the implementation of national fertility policy and the gradual increase in the number of potential sibling donors,we have not yet obtained the exact answer whether HSD transplantation has the same efficacy as MSD transplantation.To evaluate the efficacy of HSD and MSD transplantation in patients with complete remission(CR)AML,we collected clinical data of patients with CR AML who received HSD or MSD transplantation in Zhujiang Hospital from November 2016 to July 2022,and compared the survival outcomes of the two groups.MethodsWe collected the clinical data of 98 CR AML patients who underwent sibling donor transplantation in Zhujiang Hospital from November 2016 to July 2022,including 40 patients in the HSD group and 58 patients in the MSD group.Hematopoietic reconstruction,rejection(GVHD),viral infection rate,DFS and OS were compared between the two groups,and the prognostic factors were analyzed.Results1.Patients in MSD group and HSD group completed hematopoietic reconstruction.The median implantation time of neutrophils in MSD group and HSD group was 11 days(range,8-26 days)and 13 days(range,9-19 days)(p=0.400),and the median implantation time of platelets was 13 days(range,9-27 days)and 14 days(rang,10-25days)(p=0.106),respectively.There was no significant difference in hematopoietic reconstruction time.2.Within 100 days after transplantation,the cumulative incidence of aGVHD in MSD group and HSD group was(15.5±4.8)%and(40±7.7)%(p=0.004),and the cumulative incidence of Ⅱ°-Ⅳ°aGVHD was(6.9±3.3)%and(32.5±7.4)%(p=0.001),respectively.The cumulative incidence of digestive tract aGVHD was(6.9±3.3)%and(32.5±7.4)%(p=0.001),respectively.The incidence of aGVHD,Ⅱ°-Ⅳ°aGVHD and digestive tract aGVHD in HSD group were significantly higher than those in MSD group.Within 1 year after transplantation,the cumulative prevalence of cGVHD in MSD group and HSD group was(34.2±6.4)%and(34.8±8.3)%,respectively(p=0.478).The incidence of moderate or severe cGVHD accumulation were(33.3±5.7)%and(31.3±7.5)%(p=0.842),and the incidence of pulmonary cGVHD accumulation were(2.7±2.7)%and(7.1±3.4)%(p=0.484),respectively.There were no significant differences in the incidence of cGVHD,moderate or severe cGVHD,or pulmonary cGVHD between the two groups.3.There was no significant difference in the cumulative incidence of CMV infection at 1 year after transplantation between the MSD group and the HSD group(57.0±6.5%vs 67.5±7.4%,p=0.088).The cumulative incidence of EB infection within 1 year after transplantation was higher in the HSD group than in the MSD group(32.5±7.5%vs 9.0±3.8%,p=0.001).4.The 2-year overall recurrence rate and 2-years mortality rate of sibling allogeneic hematopoietic stem cell transplantation patients were 14.3%and 13.3%.The 2-year OS of the HSD group was lower than that of the MSD group(77.3±7.3%vs 89.9±4.3%,P=0.023),and the 2-year DFS of the HSD group was lower than that of the MSD group(69.6 ± 8.7%VS 89,1±4.7%,P=0.022).5.After multivariate analysis,HSD transplantation,female donor and Relapsed/refractory AML were the risk factors for disease recurrence after transplantation.Relapsed/refractory AML and HSD transplantation were risk factors for DFS.HSD transplantation is a risk factor for OS in patients.Conclusion1.In our single-center study,MSD transplantation was found to have a survival advantage over HSD transplantation in patients with CRAML,with lower incidence of aGVHD,Epstein-Barr virus infection,and better DFS and OS.2.Disease recurrence was the main cause of death after transplantation.Multivariate analysis suggested that female donors,relapsed/refractory AML and HSD transplantation were risk factors for disease recurrence after transplantation.Relapsed/refractory AML and HSD transplantation were risk factors for DFS.HSD transplantation is a risk factor for OS in patients.