Unmanipulated haploidentical hematopoietic stem cell transplantation using very low-dose antithymocyte globulin and methylprednisolone in adults with relapsed/refractory acute leukemia.
Adolescent
Adult
Aged
Allografts
Antilymphocyte Serum
/ administration & dosage
Cyclophosphamide
/ administration & dosage
Female
Graft vs Host Disease
/ blood
Graft vs Leukemia Effect
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute
/ blood
Lymphocyte Depletion
Male
Methylprednisolone
/ administration & dosage
Middle Aged
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Recurrence
Haploidentical hematopoietic stem cell transplantation
Relapsed/refractory acute leukemia
Very low-dose antithymocyte globulin
Journal
Annals of hematology
ISSN: 1432-0584
Titre abrégé: Ann Hematol
Pays: Germany
ID NLM: 9107334
Informations de publication
Date de publication:
Jan 2020
Jan 2020
Historique:
received:
18
05
2019
accepted:
20
11
2019
pubmed:
2
12
2019
medline:
15
1
2020
entrez:
2
12
2019
Statut:
ppublish
Résumé
Allogeneic hematopoietic stem cell transplantation (HSCT) could be the only curative therapy for patients with relapsed/refractory acute leukemia (RRAL). Many reports have described unmanipulated haploidentical HSCT (HID-HSCT) using high-dose antithymocyte globulin (ATG). However, the transplant outcomes of HID-HSCT using very low-dose ATG (thymoglobulin, 2-2.5 mg/kg) and methylprednisolone (mPSL, 1 mg/kg) for patients with RRAL have not been reported. We compared the outcomes of 46 patients with RRAL who underwent HID-HSCT using very low-dose ATG (thymoglobulin) and mPSL with the outcomes of 72 patients who underwent non-HID-HSCT. Patient characteristics differed regarding conditioning intensity (myeloablative; 19.6% in HID-HSCT vs. 61.1% in non-HID-HSCT, P < 0.001) and having undergone multiple HSCT (26.1% vs. 11.1%, P = 0.045). However, we found no significant differences in the 1-year overall survival (OS, 31.7% vs. 29.1%; P = 0.25), disease-free survival (DFS, 20.5% vs. 23.7%; P = 0.23), cumulative incidence of relapse (CIR, 40.0% vs. 42.8%; P = 0.92), non-relapse mortality (NRM, 39.5% vs. 33.5%; P = 0.22), or 100-day grade II-IV acute graft-versus-host disease (32.6% vs. 34.7%; P = 0.64) following HID-HSCT vs. non-HID-HSCT, respectively. Subgroup analysis stratified by disease and intensity of conditioning regimen demonstrated the same results between HID-HSCT and non-HID-HSCT. Furthermore, multivariate analysis showed that HID-HSCT was not an independent prognostic factor for OS (hazard ratio (HR) = 0.95 [95% confidence interval (CI), 0.58-1.58]), DFS (HR = 1.05 [95%CI, 0.67-1.68]), CIR (HR = 0.84 [95%CI, 0.48-1.47]), or NRM (HR = 1.28 [95%CI, 0.66-2.46]). In summary, transplant outcomes for RRAL were comparable in the HID-HSCT and non-HID-HSCT groups. HID-HSCT using very low-dose ATG and mPSL for RRAL may be a viable alternative to non-HID-HSCT.
Identifiants
pubmed: 31786646
doi: 10.1007/s00277-019-03865-x
pii: 10.1007/s00277-019-03865-x
doi:
Substances chimiques
Antilymphocyte Serum
0
Cyclophosphamide
8N3DW7272P
Methylprednisolone
X4W7ZR7023
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
147-155Références
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