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Comparison of haploidentical hematopoietic stem cell transplantation and HLA-matched transplantation for primary refractory acute myeloid leukemiaObjective To summarize the clinical efficacy of primary refractory acute myeloid leukemia(PRR-AML)in the treatment of haploidentical hematopoietic stem cell transplantation(Haplo-SCT),and further analyze the risk factors associated with prognosis and timing of transplantation.Methods We retrospectively analyzed the results of Haplo-SCT for 45 adult PRR-AML patients and compared them with 53 patients who underwent HLA-matched donor transplantation(MD-SCT)between January 2010 and December 2016 from our hospital.The 3-year OS,leukemia-free survival(LFS),cumulative incidence of relapse(CIR),and non-relapse mortality(NRM)were calculated,and the related risk factors were analyzed.Results The median follow-up time of the survival patients in the whole group was 33(12-64)months.The 3-year OS,LFS,CIR,and NRM in the Haplo-SCT group were 19.0±4.9%,16.5±4.6%,70.0±7.1%,and 35.2±7.8%,respectively,and those of the MD-SCT group were 23.1 15.1%(P=0.379),20.9±5.0%(P=0.345),64.018.2%(P=0.152),36.1±6.7%(P=0.471);The grades I to IV and III to IV acute graft-versus-host disease(GVHD)in the Haplo-SCT group were 45.5±6.1%and 18.2±6.5%,respectively,while those in the MD-SCT group were 37.7±5.4%(P=0.931)and 18.9±5.2%(P=0.442),respectively.All these results above had no significant differences between the two groups.Multivariate analysis of the entire cohort showed that the complex karyotype with del(7)and the time from diagnosis to transplantation>6 months were significantly associated with worse OS and LFS,while patients with chronic GVHD showed better OS and LFS.Patients with complex karyotype with del(7)had higher CIR,while those with chronic GVHD had lower CIR.Conclusion Haploidentical hematopoietic stem cell transplantation could be another therapeutic strategy for long-term survival in adult PRR-AML patients,especially when patients do not have HLA-matched donors.PART ? Haploidentical allogeneic hematopoietic stem cell transplantation compared to matched unrelated transplantation for Philadelphia chromosome-positiveacute lymphoblastic leukemiaObjective To investigate the efficacy of haploidentical hematopoietic stem cell transplantation(Haplo-SCT)for Philadelphia chromosome-positive acute lymphoblastic leukemia(Ph+ALL),and compare it with that of matched unrelated donor stem cell transplantation(MUD-SCT).The factors affecting prognosis were analyzed to explore the transplant options of such patients.Methods We retrospectively analyzed 58 cases of Ph+ALL diagnosed in our hospital from January 2012 to August 2015,of which 42 patients received Haplo-SCT and 16 patients did MUD-SCT.All patients were treated with tyrosine kinase inhibitors before and after transplantation,and the conditioning regimen was myeloablative.The overall survival(OS),leukemia-free survival(LFS),cumulative incidence of relapse(CIR),and non-relapse mortality(non-relapse mortality,NRM)were compared between the two groups.Results The median follow-up time of the whole group was 19 months(range,1 to 56 months).The 3-year OS,LFS,CIR,and NRM of the Haplo-SCT group and the MUD-SCT group had no significant statistical differences(69.1 vs 67.4%,P=0.638;64.3 vs 62.9%,P=0.708;19.0±6.2%vs 6.3± 5.9%,P=0.466;14.3± 5.4%vs 18.8 ± 9.6%,P=0.869;respectively).The Haplo-SCT group did not show a higher incidence of grade III-IV acute graft-versus-host disease(GVHD)than the MUD-SCT group(17.6 ± 5.2%vs 20.0 ±10.0%,P=0.603),neither did the chronic extensive GVHD(19.5 ± 7.1%vs 13.3 ± 8.6%,P=0.637).Multivariate analysis showed that chronic GVHD in the Haplo-SCT group was associated with a lower recurrence rate.Conclusion Haploidentical hematopoietic stem cell transplantation is a promising choice for improving the long-term survival in patients with Ph+ALL.It has similar efficacy with MUD-SCT and does not increase the risk associated with treatment.Especially when patients do not have HLA-matched donors,Haplo-SCT can be administrated as an alternative for Ph+ALL.PART ? Improved outcome of prophylactic low-dose decitabine after allogeneic stem cell transplantation for high-risk acute myeloid leukemiaObjective Relapse and transplantation-related complications are still the main reasons for restricting the efficacy of allogeneic hematopoietic stem cell transplantation(Allo-SCT)in high-risk acute myeloid leukemia(AML).In this study,prophylactic low-dose decitabine was administrated after Allo-SCT for high-risk AML,in order to reduce the recurrence rate post transplantation without increasing the toxicity,and to improve post-transplant survival..Methods We conducted a retrospective controlled study comparing the efficacy of the following two groups:Group T:Low-dose decitabine 15 mg/m2 qd × 3d,beginning at+55?+100 days post Allo-SCT,every 45 days a cycle,for 3 to 6 courses;Group C:those who met the inclusion criteria after Allo-SCT but did not accept the treatment.The main inclusion criteria included:(1)High-risk group AML patients with complete hematologic remission post Allo-SCT,full donor engrafted and negative minimal residual disease confirmed by flow cytometry,without serious comorbidities;(2)Patients' age 16-60 years;(3)Performance status of the Eastern Cancer Cooperative Group(ECOG)<2;(4)Absolute neutrophil count>1,000/mm3.The primary endpoints were 3-year cumulative incidence of relapse(CIR),leukemia-free survival(LFS),and overall survival(OS).Secondary study endpoints included incidence of isolated thrombocytopenia on+9 months post transplantation and 3-year incidence of chronic graft-versus-host disease(cGVHD).Results A total of 442 high-risk AML patients underwent Allo-SCT in our hospital from January 2013 to December 2017,including 86 patients in Group T and 120 patients in Group C,and 236 patients who did not meet the enrollment were excluded.There were no significant differences in baseline characteristics between the two groups.The 3-year CIR of Group T was significantly better than Group C(22.1%± 4.8%vs.37.8 ± 4.9%,P=0.039).The 3-year OS and LFS of Group T had better trend than Group C,but there were no statistical differences(62.6%+5.4%vs.52.1%14.7%,P=0.207;61.3%15.2%vs.49.5%±4.6%,P=0.077).There were 10/86(11.6%)patients with isolated thrombocytopenia on+9 months post transplantation in Group T,and 33/120 patients(27.5%,P=0.011)in Group C.The median platelet count of Group T was 110(range 10-350)×103/ul,and 78(range 3?329)×103/ul in Group C(P=0.0007).There was no significant difference in 3-year cGVHD incidence between the two groups.Conclusion Prophylactic application of low-dose decitabine could help reduce the recurrence rate of high-risk AML after Allo-SCT,decrease the incidence of isolated thrombocytopenia,which deserves further study. |
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