Haploid-matched VS Sibling-matched HSCT For High Risk ALL:a Comparative Study In Outcome

Objective Investigate the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation(allo-HSCT)in patients with high risk acute lymphoblastic leukemia(ALL).Methods We analyzed a total of 69 patients with ALL who were treated with allo-HSCT from July 2007 to August 2013,all patients were followed up for more than two years post transplantation.According to transplantation type,they were divided into haploid-matched group(n=42)and sibling-matched group(n=27).Clinical characteristics and efficacy of two groups were retrospectively analyzed.Survival were analyzed by the Kaplan-Meier method and the prognostic factors were analyzed with the COX regression model.Results In haploid-matched group,2 years OS(over-all survival)and 2 year LFS(leukemia-free survival)are 63.4% and 59.4%,respectively.In sibling-matched group,2 years OS and 2 year LFS are 53.9% and 53.7%,respectively.Difference was not statistically significant(P>0.05)in two group.Difference of 2 year NRM(non-relapse mortality)rate was not statistically significant(P>0.05)between the two group.But 2 years RR(cumulative relapse rate)of sibling-matched group(39.5%)is significantly higher than that of haploid-matched group(19.5%)(P=0.014).In hematopoietic reconstruction,neutrophils reconstruction of the haploid-matched group slower than sibling-matched group(P=0.002),and platelet reconstruction in two group is similar(P=0.072).Grade I-II acute GVHD(graft-versus-host disease)in haploid-matched group is higher than sibling-matched group(P=0.008),then grade III-IV acute GVHD and chronic GVHD are similar(P>0.05)in both groups.The early(six months)infection incidents after HSCT is higher in haploid-matched group than that of sibling-matched group(P=0.02).The Cox regression analysis showed that disease status before transplantation(not CR1)were main risk factors(P=0.001),relative risks is 7.581.The Limited chronic GVHD(P=0.013)and duration from first diagnosed to transplantation(P=0.012)are protective factors with their relative risks as 0.178 and 0.688 respectively.Conclusion In high-risk patients with ALL,haploid-matched and sibling-matched HSCT are similar in overall outcome,so haploid-matched donor can be suitable source of allogeneic stem cell transplantation.