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The lower relapse rate and better survival advantages of haploidentical allograft compared with HLA-matched sibling donor allografts for intermediate- and adverse-risk AML patients with pretransplantation minimal residual disease

Bone Marrow Transplantation volume 58, pages 215–218 (2023)Cite this article

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Allogeneic stem cell transplantations (allo-SCT), including human leukocyte antigen (HLA)-matched sibling donor transplantation (MSDT), HLA-matched unrelated donor transplantation (MUDT), haploidentical SCT (haplo-SCT) and umbilical cord blood transplantation, are still curative therapies for acute myeloid leukemia (AML) patients [1]. In recent years, several studies have suggested that, for AML patients with positive pre-SCT minimal/measurable residual disease (MRD), the cumulative incidence of relapse (CIR) after haplo-SCT was significantly lower than after MSDT, which leads to better survival [2]. Therefore, we performed this large sample, retrospective study to investigate the advantages and disadvantages of CIR and survival between haplo-SCT and MSDT for the therapy of intermediate- and adverse-risk AML patients with positive pre-SCT MRD.

A total of 940 AML patients in their first complete remission (CR1) who underwent allo-HSCT at Peking University People’s Hospital from Jan 1, 2012 to Dec 30, 2018 were included in this retrospective study (Supplementary Fig. S1). The diagnosis of AML risk was based on cytogenetics/genetics (ELN2017) [3]. Unmanipulated allo-SCT was performed as previously reported by our group [4]. Multicolor flow cytometry (MFC) was performed on bone marrow aspirate samples that were obtained for all patients before SCT as previously described [5, 6]. Cumulative incidence of NRM and the probabilities of leukemia-free survival (LFS) and overall survival (OS) were estimated using the Kaplan–Meier product limit estimation method [7]. 100-day acute GVHD (aGVHD) and chronic GVHD (cGVHD) were diagnosed and graded according to the standard international criteria [8,9,10]. Relapse was defined by morphologic evidence in the marrow, peripheral blood or extramedullary sites [11]. NRM was defined as death without relapse and regarded as a competing risk for relapse, and relapse was considered a competing risk of NRM. Multivariate analyses were performed using Cox proportional hazards regression model for main outcomes. Age, donor source, conditioning regimen and cytogenetics and other p < 0.1 variables were analyzed with multivariable analysis using a Cox proportional hazards model. p < 0.05 was considered statistically significant. Statistical analyses were performed using SPSS 20.0 (Mathsoft, Seattle, WA, USA) and R version 4.2.0 (R Development Core Team, Vienna, Austria) were used for all data analysis.

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Fig. 1: Prognostic impact of transplant modality in the intermediate- or adverse-risk group in MRDpospatients.

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The data for this article are not publicly available. Requests to access the data should be contacted the corresponding authors.

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Acknowledgements

This work was supported by the National Key Research and Development Program (2017YFA0104500 & 2019YFC0840606), National Natural Science Foundation of China (81870139, 81530046 & 81930004), the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (81621001), the Peking University Clinical Scientist Program (BMU2019LCKXJ003), and the Science and Technology Project of Guangdong Province of China (2016B030230003).

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Authors and Affiliations

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

    Ming Wang, Bixia Wang & Xiao-Jun Huang

  2. Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China

    Ming Wang, Bixia Wang, Lan-Ping Xu, Yu Wang, Xiao-Hui Zhang, Yi-fei Cheng, Yu-Qian Sun, Yuan-Yuan Zhang, Yan-Rong Liu, Ying-Jun Chang, Kai-Yan Liu & Xiao-Jun Huang

  3. Peking-Tsinghua Center for Life Sciences, Beijing, China

    Xiao-Jun Huang

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  1. Ming Wang
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Contributions

X-JH and Y-JC designed the study; MW, B-XW collected data; MW, L-PX and YW analyzed data; Y-JC and MW drafted the manuscript; All authors contributed to data interpretation and manuscript preparation and approved the final version.

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Correspondence to Xiao-Jun Huang.

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Wang, M., Wang, B., Xu, LP. et al. The lower relapse rate and better survival advantages of haploidentical allograft compared with HLA-matched sibling donor allografts for intermediate- and adverse-risk AML patients with pretransplantation minimal residual disease. Bone Marrow Transplant 58, 215–218 (2023). https://doi.org/10.1038/s41409-022-01872-7

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