Comparison of autologous versus matched sibling donor stem cell transplantation for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia
10.3760/cma.j.issn.0253-2727.2020.05.003
- VernacularTitle:自体与同胞全相合造血干细胞移植治疗Ph +急性淋巴细胞白血病的疗效比较
- Author:
Mengnan LYU
1
;
Erlie JIANG
;
Yi HE
;
Donglin YANG
;
Qiaoling MA
;
Aiming PANG
;
Weihua ZHAI
;
Jialin WEI
;
Yong HUANG
;
Guixin ZHANG
;
Rongli ZHANG
;
Sizhou FENG
;
Mingzhe HAN
Author Information
1. 中国医学科学院血液病医院（中国医学科学院血液学研究所），实验血液学国家重点实验室，国家血液系统疾病临床医学研究中心，天津 300020
- Keywords:
Philadelphia chromosome-positive acute lymphoblastic leukemia;
Allogeneic stem cell transplantation;
Autologous stem cell transplatation;
Complete molecu
- From:
Chinese Journal of Hematology
2020;41(5):373-378
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy of autologous HSCT (auto-HSCT) with matched sibling donor (MSD) HSCT in Ph + ALL and provide a basis for the choice of transplantation method. Methods:We retrospectively investigated the outcomes of 78 adult patients with Ph + ALL who underwent auto-HSCT ( n=31) and MSD-HSCT ( n=47) in Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, from January 2008 to December 2017. The overall survival (OS) rate, leukemia-free survival (LFS) rate, cumulative incidence of relapse (CIR) rate, nonrelapse mortality (NRM) rate, and the impact of achievement of complete molecular response (CMR) within 3 months and sustaining CMR up to transplantation (s3CMR) on transplantation method were explored. Results:The median time of neutrophil and platelet reconstitution in auto-HSCT and MSD-HSCT groups were 12 (10-29) days vs14 (11-24) days ( P=0.006) and 17.5 (10-62) days vs 7 (10-33) days ( P=0.794) , respectively. In the MSD-HSCT group, the incidence of Ⅱ-Ⅳ and Ⅲ-Ⅳ acute graft-versus-host disease (GVHD) was 27.7% (13/47) and 8.5% (4/47) , respectively. The incidence of limited and extensive chronic GVHD was 17.0% (8/47) and 12.8% (6/47) , respectively. The estimated CIR, NRM, LFS, and OS at 3 years were not significantly different between auto-HSCT and MSD-HSCT groups ( P>0.05) . For 44 patients who achieved s3CMR, 3-year OS[ (84.0±8.6) % vs (78.0±8.7) %, P=0.612], LFS[ (70.3±10.3) % vs (68.2±10.1) %, P=0.970], CIR[ (24.9±10.0) % vs (14.4±8.0) %, P=0.286], and NRM[ (4.7±4.7) % vs (17.4±8.1) %, P=0.209] of the auto-HSCT and MSD-HSCT groups were not significantly different. However, for 34 patients who did not reach s3CMR, 3-year cumulative relapse rate of patients in the auto-HSCT group was significantly higher than MSD-HSCT group[ (80.0±14.7) % vs (39.6±10.9) %, P=0.057]. Conclusions:auto-HSCT with maintenance therapy after HSCT appears to be an attractive treatment option for patients with Ph + ALL especially for those with s3CMR maintained up to transplantation. For non-s3CMR patients, allogeneic transplantation may be more effective from lower relapse.
