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Acute Leukemia

Idarubicin-intensified haploidentical HSCT with GvHD prophylaxis of ATG and basiliximab provides comparable results to sibling donors in high-risk acute leukemia

Bone Marrow Transplantation volume 52, pages 1253–1260 (2017)Cite this article

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Abstract

We designed a novel haploidentical hematopoietic stem cell transplantation (haplo-HSCT) system using idarubicin (IDA) intensified conditioning regimens and combination of antithymocyte globulin and basiliximab for GvHD prophylaxis. The outcomes of 110 high-risk acute leukemia patients undergoing haplo-HSCT were compared with 69 contemporaneous high-risk patients receiving HLA-matched sibling transplantation using uniform IDA-intensified regimens. The relapse incidence of haplo-HSCT was 23.4%, and 3-year overall survival (OS) and disease-free survival (DFS) achieved 62.9%, 59.1%, respectively. The cumulative incidences of II–IV and III–IV aGvHD were 28.6 and 14.3%, while limited and extensive cGvHD were 19.4, 13.8%. All these results were equivalent to those of concurrent identical sibling transplantation. Three-year OS and DFS for patients in advance stage reached 48.5, 47.3%. Furthermore, the relapse, 3-year OS of positive minimal residual disease (MRD) patients did not differ from negative MRD patients (18.9% vs 11.5%, 63.6% vs 69.6%), indicating our intensified haplo-HSCT technique could circumvent the dismal prognosis of MRD. These data provide reinforcing evidence that our haplo-HSCT system could dramatically improve the survival of high-risk acute leukemia with low relapse and acceptable transplantation-related mortality, and might be a promising therapeutic option for high-risk patients.

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Acknowledgements

This work was supported by grant from the National Natural Sciences foundation of China (Grant number: 81370668 for Ling-Hui Xia) and Collaborative Innovation Center of Hematology of China.

Author contributions

L-HX and Q-LW designed the protocol; RZ and WS contributed patients, analyzed the data and wrote the manuscript; H-FW, YY, Z-DZ, W-ML and CZ contributed patients and critically reviewed the manuscript; XL and PZ performed the statistical analysis; JF and MH provided clinical and laboratory data, revised and corrected the manuscript, and all authors read and approved the final version of the manuscript.

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  1. R Zhang and W Shi: These authors contributed equally to this work.

Authors and Affiliations

  1. Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China,

    R Zhang, W Shi, H-F Wang, Y You, Z-D Zhong, W-M Li, C Zhang, X Lu, Y-D Wang, P Zheng, J Fang, M Hong, Q-L Wu & L-H Xia

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Zhang, R., Shi, W., Wang, HF. et al. Idarubicin-intensified haploidentical HSCT with GvHD prophylaxis of ATG and basiliximab provides comparable results to sibling donors in high-risk acute leukemia. Bone Marrow Transplant 52, 1253–1260 (2017). https://doi.org/10.1038/bmt.2017.100

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