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Haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for the treatment of philadelphia chromosome-positive acute lymphoblastic leukemia.

Abstract
The role of haploidentical related allogeneic hematopoietic stem cell transplantation (allo-HSCT) in Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph(+) ALL) is not clear. We aimed to investigate the long-term survival of Ph(+) ALL patients who underwent haploidentical donor (HID)-HSCT and to analyze the factors influencing relapse and survival after allo-HSCT. The study population included Ph(+) ALL patients who underwent haploidentical related allo-HSCT. Additionally, Ph(+) ALL patients who underwent HLA-matched related donor (MRD) transplants during the same period were included to compare outcomes. BCR-ABL transcript levels were analyzed by using real-time quantitative reverse transcription PCR. Clinical data from 139 Ph(+) ALL patients who received allo-HSCT in our center were analyzed. Of these patients, 101 received HID transplants and 38 received MRD transplants. At a median follow-up of 36 months, 5-year disease-free survival (DFS) and overall survival (OS) rates in the HID transplant group were 65.8% and 74.0%, respectively. The 5-year cumulative incidence of relapse (CIR) and nonrelapse mortality (NRM) rates for the HID transplant group were 20.3% and 15.6%, respectively. In addition, there were no differences in OS, DFS, CIR, and NRM between the HID and MRD groups. Multivariate analysis showed that imatinib resistance was a significant factor influencing DFS and CIR in HID transplant patients. Haploidentical HSCT for the treatment of Ph(+) ALL achieves promising long-term survival, which is comparable with that of HLA-MRD HSCT. Imatinib resistance is a negative predictor of relapse and DFS after allo-HSCT.
AuthorsHuan Chen, Kai-yan Liu, Lan-ping Xu, Yu-hong Chen, Wei Han, Xiao-hui Zhang, Yu Wang, Ya-zhen Qin, Yan-rong Liu, Xiao-jun Huang
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 21 Issue 6 Pg. 1110-6 (Jun 2015) ISSN: 1523-6536 [Electronic] United States
PMID25698612 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2015. Published by Elsevier Inc.
Chemical References
  • BCR-ABL1 fusion protein, human
  • Immunosuppressive Agents
  • Myeloablative Agonists
  • Imatinib Mesylate
  • Fusion Proteins, bcr-abl
Topics
  • Acute Disease
  • Adult
  • Drug Resistance, Neoplasm (genetics)
  • Female
  • Fusion Proteins, bcr-abl (genetics, immunology)
  • Gene Expression
  • Graft vs Host Disease (genetics, immunology, mortality, prevention & control)
  • Haplotypes
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Imatinib Mesylate (therapeutic use)
  • Immunosuppressive Agents (therapeutic use)
  • Male
  • Middle Aged
  • Myeloablative Agonists (therapeutic use)
  • Philadelphia Chromosome
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma (genetics, immunology, mortality, therapy)
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Siblings
  • Survival Analysis
  • Transplantation Conditioning (methods)
  • Transplantation, Homologous
  • Unrelated Donors

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