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Stem cell transplantation

Haploidentical transplantation might have superior graft-versus-leukemia effect than HLA-matched sibling transplantation for high-risk acute myeloid leukemia in first complete remission: a prospective multicentre cohort study

Leukemia volume 34, pages 1433–1443 (2020)Cite this article

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Abstract

This study aimed to investigate graft-versus-leukemia (GVL) of haploidentical donor (HID) compared with HLA-matched sibling donor (MSD) for high-risk acute myeloid leukemia (H-AML) in first complete remission (CR1). One hundred and eighty-nine patients with H-AML in CR1 were enrolled in this multicentre prospective cohort study. Patients were assigned to groups transplanted with HID (n = 83) or MSD (n = 106) based on donor availability (biological randomization). The primary endpoint was the incidence of MRD positivity posttransplantation (post-MRD+). All post-MRD+ patients received preemptive interventions. The cumulative incidences of post-MRD+ were 18 and 42% in HID and MSD groups, respectively, (p < 0.001). Fifty-two patients received preemptive DLI, including 13 (16%) in HID and 39 cases (37%) in MSD groups (p = 0.001). Among HID and MSD groups, the 3-year cumulative incidence of relapse were 14 and 24% (p = 0.101); the 3-year cumulative incidence of treatment-related mortality were 15 and 10% (p = 0.368); the 3-year overall survival rates were 72 and 68% (p = 0.687); the 3-year disease-free-survival were 71 and 66% (p = 0.579); the 3-year graft-versus-host disease and relapse free survival were 63 and 43% (p = 0.035), respectively. HID might have a stronger GVL than MSD in H-AML patients. HID transplantation as postremission therapy should be recommended as one of the optimal choices for H-AML patients in CR1.

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Fig. 1
Fig. 2: Post-MRD+, relapse and TRM.
Fig. 3: Survival rates according to donor source.

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Acknowledgements

This work was supported by the National Key Research and Development Programme of China (Grant nos. 2017YFA105500, 2017YFA105504), the National Natural Science Foundation of China (nos. 81770190, 81700176, 81470349, and 81770189), the Science and Technology Program of Guangdong Province (Grant nos. 2014B020226004, 2016B030230003), the Science and Technology Program of Guangzhou (Grant no. 201704020214). We thank all the faculty members that participated in this study.

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  1. These authors contributed equally: Sijian Yu, Fen Huang, Yu Wang

Authors and Affiliations

  1. Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Sijian Yu, Fen Huang, Zhiping Fan, Ren Lin, Na Xu, Li Xuan, Jieyu Ye, Jing Sun, Xiaojun Huang & Qifa Liu

  2. Department of Hematology, Nanhai Hospital, Southern Medical University, Foshan, China

    Sijian Yu

  3. Peking University Institute of Hematology, Peking University People’s Hospital, Beijing, China

    Yu Wang, Wenjing Yu & Xiaojun Huang

  4. Department of Hematology, Xiangya Hospital, Central South University, Changsha, China

    Yajing Xu

  5. Department of Hematology, Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China

    Ting Yang

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Contributions

Conception and design: Q-FL, X-JH. Acquisition of data (acquired and managed patients, provided facilities, etc.): S-JY, FH, YW, Z-PF, RL, NX, LX, TY, Y-JX, J-YY, W-JY and JS. Analysis and interpretation of data (e.g., statistical analysis, biostatistics, and computational analysis): S-JY, FH, YW. Writing, review, and/or revision of the paper: Q-FL, X-JH, S-JY, FH, and YW. Administrative, technical, or material support (i.e., reporting or organizing data, constructing databases): Q-FL, X-JH. Study supervision: Q-FL, X-JH.

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Correspondence to Xiaojun Huang or Qifa Liu.

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Yu, S., Huang, F., Wang, Y. et al. Haploidentical transplantation might have superior graft-versus-leukemia effect than HLA-matched sibling transplantation for high-risk acute myeloid leukemia in first complete remission: a prospective multicentre cohort study. Leukemia 34, 1433–1443 (2020). https://doi.org/10.1038/s41375-019-0686-3

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