Blood Res.  2020 Mar;55(1):27-34. 10.5045/br.2020.55.1.27.

Similar transplant outcomes between haploidentical and unrelated donors after reduced-intensity conditioning with busulfan, fludarabine, and anti-thymocyte globulin in patients with acute leukemia or myelodysplastic syndrome

Affiliations
  • 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. stephano.dyshin@gmail.com
  • 2Center for Medical Innovation, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
  • 3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

BACKGROUND
Although T-cell-replete hematopoietic cell transplantation (HCT) from haploidentical donors (HIDs) using anti-thymocyte globulin (ATG) has shown promising outcomes, previous studies often adopted heterogenous graft sources and conditioning.
METHODS
We retrospectively compared HCT outcomes from 62 HIDs, 36 partially-matched unrelated donors (PUDs), and 55 matched unrelated donors (MUDs) in patients with acute leukemia or myelodysplastic syndrome using the same graft source of peripheral blood and a reduced intensity conditioning of busulfan, fludarabine, and ATG.
RESULTS
The estimates of 3-yr disease-free survival (DFS) and overall survival (OS) rates were not significantly different among the MUD, HID, and PUD groups, at 46%, "41%, and 36%" for the DFS rate (P=0.844), and 55%, 45%, and 45% for the OS rate (P=0.802), respectively. Cumulative incidence of relapse and non-relapse mortality at 3 yr was similar among different donor types. Subsequent multivariable analyses showed that the sex of the patient (male) and a high/very high disease risk index were independently associated with poorer DFS and OS, while the donor type was not.
CONCLUSION
T-cell replete HCT from HIDs using an ATG-containing reduced intensity conditioning regimen may be a reasonable option in the absence of matched related donors in patients with acute leukemia or myelodysplastic syndrome.

Keyword

Haploidentical stem cell transplantation; HLA-matched unrelated donor; Reduced-intensity conditioning; Anti-thymocyte globulin

MeSH Terms

Antilymphocyte Serum*
Busulfan*
Cell Transplantation
Disease-Free Survival
Humans
Incidence
Leukemia*
Mortality
Myelodysplastic Syndromes*
Recurrence
Retrospective Studies
T-Lymphocytes
Tissue Donors
Transplants
Unrelated Donors*
Antilymphocyte Serum
Busulfan
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