Clinical Observation Of Idarubicin Intensified Haploidentical Hematopoietic Stem Cell Transplantation In The Treatment Of Patients With High-risk Acute Leukemia

Objective:To study the safety and efficacy of idarubicin intensified conditioning regimen haploidentical hematopoietic stem cell transplantation in the treatment of high risk acute leukemia.Methods:A total of 16 patients with high risk acute leukemia who underwent idarubicin intensified Haplo-HSCT between January 2015 and September 2018 were enrolled in our study,including AML 10 cases,ALL 3cases,MAL 1 case,MDS-RAEB2 2 cases.The median age was 28 years(13-50years).11 cases were in complete remission,1 in partial remission,and 4 in non-remission before transplantation.The conditioning regimens were as follow:IDA+TBI+CY+VP-16+ATG;IDA+TBI+CY+ATG;IDA+BU+CY+ATG.Cyclosporin A(CsA)or tacrolimus(FK506),Mycophenolate mofetil(MMF),methotrexate(MTX)were applied in GVHD prophylaxis with or not anti-thymocyte globulin(ATG).The doses were as follow:IDA 20mg/m~2(d-12 to d-11 or d-10);TBI 10Gy(d-10 to d-9);Bu 0.8mg/kg q6h(d-8 to d-5);VP-16200mg/m~2(d-4);CTX60mg/kg(d-4 to d-3);ATG 2.5mg/kg(d-4,d-1).Relapse rate,overall survival(OS)and disease-free survival(DFS)were considered in evaluating the safety and efficacy of IDA-intensified conditioning regime.Results:The median follow-up time was 9.5 months(0.8-50 months).All patients accessed hematopoietic reconstruction,excepting 1 case failed in both neutrophil and platelet recovery.The median time for neutrophil reconstruction was 11(9-17)days,and the median time for platelet reconstruction was14(10-35)days.4 patients occurred graft-versus-host disease,2 cases of I-II degree acute graft-versus-host disease(aGVHD)and limited chronic graft-versus-host disease(cGVHD)respectively included.Transplant-related mortality was 26%(3 cases death of effction,1 case death of graft failure).Relapse detected in 2 patients and they all died in the follow-up duration.Relapse rate was 16.4%.1 year OS and DFS were 61.1%,61.9%respectively.Conclusion:Our retrospective study indicates that the IDA-intensified conditioning regimen may be safety and suit to patients who received Haplo-HSCT with high risk acute leukemia by decreasing relapse rate.The privilege of this intensified regimen needs further confirm on a larger multi-center randomized controlled trail study.