| Purpose:Allogeneic hematopoietic stem cell transplantation(allo-HSCT)is an important method to treat acute lymphoblastic leukemia(ALL)patients.We compared outcomes of allo-HSCT performed to treat ALL using matched sibling donor(MSD),unrelated donors(URD)and haploidentical related donors(HRD)and to analyze the risk factors which have effects on survival after allo-HSCT.Methods:We retrospectively analyzed 211 patients with ALL who received allo-HSCT at our center from January 2010 to December 2016.116 men and 95 women.The median age was 27(range 11-54)years old.There were 69 standard-risk patients,142 high-risk patients.37 patients underwent MSD-HSCT,52 underwent URD-HSCT and 122 underwent HRD-HSCT.Engraftment、graft-versus-host disease(GVHD)、overall survival(OS)、leukemia free survival(LFS)、relapse and non-relapse mortality(NRM)were compared among the three groups.Results:The median follow-up was 31.7(range 0.4-107.0)months.The 15-day engraftment rate of neutrophils(ANC)in the HRD-HSCT were lower than that in the MSD-HSCT and URD-HSCT(P=0.001,P<0.001);The 15-day engraftment rate of platelets(PLT)in the HRD-HSCT were lower than that in the MSD-HSCT and URD-HSCT(P=0.025,P=0.002).The incidences of+100 days grade II to IV aGVHD in MSD-HSCT、HRD-HSCT and URD-HSCT were 10.8%、33.6%and 26.9%,respectively,and the MSD-HSCT was associated with a lower incidence of grade II to IV aGVHD compared with HRD-HSCT(P=0.004)and URD-HSCT(P=0.048).The incidence of grade II to IV aGVHD in the URD-HSCT was not different from HRD-HSCT(P=0.345).There was no difference in grade III to IV aGVHD incidence between the three groups(P>0.05).The five year NRM in MSD-HSCT、HRD-HSCT and URD-HSCT were 6.0%,13.1%and 11.5%,respectively,and it did not differ among three groups(P>0.05).The five year cumulative relapse rate after allo-HSCT in sibling、haploidentical and unrelated donor were 51.4%,32.4%and 28.8%,respectively,the MSD-HSCT was associated with a higher incidence of five year cumulative relapse rate compared with HRD-HSCT and URD-HSCT(P=0.030,P=0.025).There was no difference in the five year cumulative relapses rate between the three groups in 163 ALL patients who were in CR1 status.For MSD-HSCT,the five year OS and LFS were 52.2%and 42.7%respectively.For HRD-HSCT,the five year OS and LFS were 58.4%and 54.5%respectively.For URD-HSCT,the five year OS and LFS were 61.5%and 59.6%respectively.Statistical analysis showed that the five year OS and LFS had no statistical differences between the three groups(P>0.05).On multivariable analysis,high risk disease、unremission status and grade III to IV aGVHD were independent risk factors on survival after allo-HSCT.Conclusion:Our data indicate that HRD-HSCT results in outcomes equivalent to MSD-HSCT for ALL.HRD-HSCT could be a valid alternative for ALL patients lacking a sibling donor. |
