| Objective:In this study,we aimed to evaluate the efficacy and safety of the competitive transplantation of the haploidentical hematopoietic with cord blood for hematologic malignancies.Methods:This study was conducted as a retrospective review of the medical records of 55 patients with hematologic malignancies who received the competitive transplantation of haploidentical hematopoietic with cord blood at the Fujian Medical University Union Hospital from November 2016 to December 2019.Results:Among the 55 patients with hematologic malignancies（median age=27years[range:6–57 years]）,30 were patients with CR,and 25 were refractory/relapsed patients.Conditioning regimen was modified using low-dose antithymocyte globulin（5mg/kg）on the basis of FABu Cy regimen.The prophylaxis for graft-versus-host disease（GVHD）was applied using Cs A and MMF plus PTCy.The median values of the absolute total nucleated cell counts were 13.3×108 kg-1(range:3.7×108–94.8×108kg-1)in the haploidentical grafts and 2.3×107 kg-1(range:0.7×107–13.0×107 kg-1)in the cord blood units.The median doses of the infused CD34+cells were 7.0×106kg-1(range:1.2×106–29.8×106kg-1)in the haploidentical grafts and 1.3×105kg-1(range:0.1×105–13.0×105kg-1)in the cord blood units.The cumulative incidence of neutrophil engraftment was 98.2%.For the chimerism test using str medthod,A total of28 were haploidentical engraftment,and 27 were cord blood engraftment.The median durations of myeloid engraftment were 15 days（range:12–37 days）and 15 days（range:10–60 days）for platelets,and the cumulative platelet engraftment incidence was 89.1%.During the median followup of 10.7 months（range:2.9–39.5 months）,the cumulative incidence of gradesⅡ–ⅣandⅣ–Ⅳac ute GVHD were 33.2%and 7.5%,respectively.The cumulative incidences of limited and severe chronic GVHD were 21.9%and 8.4%,respectively.The estimated 1-year OS,DFS,GRFS,NRM,relapse,and RM rates were71.3%,67.4%,65.3%,20.4%,14.8%,and 10.4%,respectively.The patients with CR and refractory/relapse had estimated 1-year OS rates（P=0.44）of 79.4%and 68.4%,respectively;DFS rates（P=0.54）of 68.8%and 66.9%,respectively;NRM rates（P=0.53）of 17.5%and 24%,respectively;and relapse rates（P=0.37）of 13.3%and 15.1%,respectively.The haploidentical peripheral blood and cord blood implantation had estimated 1-year OS rates（P=0.06）of 60%and 85%,respectively;DFS rates（P=0.04）of 53.2%and 85%,respectively;NRM rates（P=0.32）of 25.3%and 15.3%,respectively;and relapse rates（P=0.19）of 24.8%and 3.7%,respectively.Conclusion:Results suggested that the competitive transplantation of haploidentical hematopoietic with cord blood may improve the outcome of hematopoietic stem cell transplantation.This method offers a transplant alternative for patients with hematologic malignancies who lack matching donors. |
