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HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: improved outcomes in patients in accelerated phase and blast crisis phase.
Ann Med. 2008; 40(6):444-55.AM

Abstract

BACKGROUND

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only proven curative therapy for chronic myeloid leukemia (CML), but lack of human leukocyte antigen (HLA)-matched sibling or unrelated donors has restricted its application. Recently, we developed an effective method for haploidentical allo-HSCT achieving comparable outcomes to HLA-identical transplantation.

AIM

To evaluate the outcomes of CML patients who underwent haploidentical allo-HSCT.

METHODS

Ninety-three patients were treated with a modified busulfan (BU)/cyclophosphamide (CY) 2 regimen, including antithymocyte globulin followed by unmanipulated blood and marrow transplantation.

RESULTS

Our data showed that the cumulative incidence of acute graft-versus-host disease (GVHD) was 64.52%, and grade III-IV was 26.45%, 61.79% had chronic GVHD, and 28.93% had extensive chronic GVHD. Non-relapse mortality varied at 8.72% (100 days), 20.72% (1 year) and 20.72% (2 years). Probability of 1-year and 4-year leukemia-free survival was similar in chronic phase (CP) 1, CP2/CR2, accelerated phase, and blast crisis patients. Probability of 4-year overall survival varied as 76.5% (CP1), 85.7% (CP2/CR2), 73.3% (accelerated phase), and 61.5% (blast crisis). Multivariate analysis indicated that factors affecting transplantation outcomes were HLA-B+DR mismatches versus others for II-III acute GVHD and III-IV acute GVHD, the stage of disease at transplantation for relapse, and the time from diagnosis to transplantation for leukemia-free survival, overall survival, and transplantation-related mortality. In our protocol, survival of HSCT for advanced CML was similar to stable stage.

CONCLUSIONS

For patients lacking an HLA-identical related donor, haploidentical relatives are alternative HSCT donors.

Authors+Show Affiliations

Peking University Institute of Hematology, People's Hospital, Beijing, China. xjhrm@medmail.com.cnNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18608121

Citation

Xiao-Jun, Huang, et al. "HLA-mismatched/haploidentical Hematopoietic Stem Cell Transplantation Without in Vitro T Cell Depletion for Chronic Myeloid Leukemia: Improved Outcomes in Patients in Accelerated Phase and Blast Crisis Phase." Annals of Medicine, vol. 40, no. 6, 2008, pp. 444-55.
Xiao-Jun H, Lan-Ping X, Kai-Yan L, et al. HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: improved outcomes in patients in accelerated phase and blast crisis phase. Ann Med. 2008;40(6):444-55.
Xiao-Jun, H., Lan-Ping, X., Kai-Yan, L., Dai-Hong, L., Huan, C., Wei, H., Yu-Hong, C., Jing-Zhi, W., Yao, C., Xiao-Hui, Z., Hong-Xia, S., & Dao-Pei, L. (2008). HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: improved outcomes in patients in accelerated phase and blast crisis phase. Annals of Medicine, 40(6), 444-55. https://doi.org/10.1080/07853890801908903
Xiao-Jun H, et al. HLA-mismatched/haploidentical Hematopoietic Stem Cell Transplantation Without in Vitro T Cell Depletion for Chronic Myeloid Leukemia: Improved Outcomes in Patients in Accelerated Phase and Blast Crisis Phase. Ann Med. 2008;40(6):444-55. PubMed PMID: 18608121.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: improved outcomes in patients in accelerated phase and blast crisis phase. AU - Xiao-Jun,Huang, AU - Lan-Ping,Xu, AU - Kai-Yan,Liu, AU - Dai-Hong,Liu, AU - Huan,Chen, AU - Wei,Han, AU - Yu-Hong,Chen, AU - Jing-Zhi,Wang, AU - Yao,Chen, AU - Xiao-Hui,Zhang, AU - Hong-Xia,Shi, AU - Dao-Pei,Lu, PY - 2008/7/9/pubmed PY - 2009/3/21/medline PY - 2008/7/9/entrez SP - 444 EP - 55 JF - Annals of medicine JO - Ann Med VL - 40 IS - 6 N2 - BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only proven curative therapy for chronic myeloid leukemia (CML), but lack of human leukocyte antigen (HLA)-matched sibling or unrelated donors has restricted its application. Recently, we developed an effective method for haploidentical allo-HSCT achieving comparable outcomes to HLA-identical transplantation. AIM: To evaluate the outcomes of CML patients who underwent haploidentical allo-HSCT. METHODS: Ninety-three patients were treated with a modified busulfan (BU)/cyclophosphamide (CY) 2 regimen, including antithymocyte globulin followed by unmanipulated blood and marrow transplantation. RESULTS: Our data showed that the cumulative incidence of acute graft-versus-host disease (GVHD) was 64.52%, and grade III-IV was 26.45%, 61.79% had chronic GVHD, and 28.93% had extensive chronic GVHD. Non-relapse mortality varied at 8.72% (100 days), 20.72% (1 year) and 20.72% (2 years). Probability of 1-year and 4-year leukemia-free survival was similar in chronic phase (CP) 1, CP2/CR2, accelerated phase, and blast crisis patients. Probability of 4-year overall survival varied as 76.5% (CP1), 85.7% (CP2/CR2), 73.3% (accelerated phase), and 61.5% (blast crisis). Multivariate analysis indicated that factors affecting transplantation outcomes were HLA-B+DR mismatches versus others for II-III acute GVHD and III-IV acute GVHD, the stage of disease at transplantation for relapse, and the time from diagnosis to transplantation for leukemia-free survival, overall survival, and transplantation-related mortality. In our protocol, survival of HSCT for advanced CML was similar to stable stage. CONCLUSIONS: For patients lacking an HLA-identical related donor, haploidentical relatives are alternative HSCT donors. SN - 0785-3890 UR - https://www.unboundmedicine.com/medline/citation/18608121/HLA_mismatched/haploidentical_hematopoietic_stem_cell_transplantation_without_in_vitro_T_cell_depletion_for_chronic_myeloid_leukemia:_improved_outcomes_in_patients_in_accelerated_phase_and_blast_crisis_phase_ L2 - https://www.tandfonline.com/doi/full/10.1080/07853890801908903 DB - PRIME DP - Unbound Medicine ER -