Haploidentical transplantation has a superior graft-versus-leukemia effect than HLA-matched sibling transplantation for Ph- high-risk B-cell acute lymphoblastic leukemia

作     者：Fan Menglin Wang Yu Lin Ren Lin Tong Huang Fen Fan Zhiping Xu Yajing Yang Ting Xu Na Shi Pengcheng Nie Danian Lin Dongjun Jiang Zujun Wang Shunqing Sun Jing Huang Xiaojun Liu Qifa Xuan Li Menglin Fan;Yu Wang;Ren Lin;Tong Lin;Fen Huang;Zhiping Fan;Yajing Xu;Ting Yang;Na Xu;Pengcheng Shi;Danian Nie;Dongjun Lin;Zujun Jiang;Shunqing Wang;Jing Sun;Xiaojun Huang;Qifa Liu;Li Xuan

作者机构：Department of HematologyNanfang HospitalSouthern Medical UniversityGuangzhouGuangdong 510515China Department of HematologyPeking University People’s HospitalPeking University Institute of HematologyBeijing 100044China Department of HematologyXiangya HospitalCentral South UniversityChangshaHunan 110051China Department of HematologyFujian Institute of HematologyFujian Medical University Union HospitalFuzhouFujian 350001China Department of HematologySun Yat-Sen Memorial HospitalSun Yat-sen UniversityGuangzhouGuangdong 510130China Department of HematologyThe Third Affiliated HospitalSun Yat-sen UniversityGuangzhouGuangdong 510630China Department of HematologyGuangzhou General Hospital of Guangzhou Military CommandGuangzhouGuangdong 510010China Department of HematologyGuangzhou First People’s HospitalGuangzhouGuangdong 510080China 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2022年第135卷第8期

页      面：930-939页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：National Natural Science Foundation of China(Nos. 81770190, 81970161) National Key Research and Development Program of China(Nos. 2017YFA105500,2017YFA105504) Research and Development Program in Key Areas of Guangdong Province(No. 2019B020236004) Natural Science Foundation of Guangdong Province(No. 2019A1515011924) Project of the Zhujiang Science and Technology Star of Guangzhou City(No. 201806010029) Key Clinical Research Project of Southern Medical University(No. LC2016ZD009)。 

主　　题：Haploidentical HLA-matched sibling Philadelphia-negative high-risk B-cell acute lymphoblastic leukemia Graft-versus-leukemia Transplantation 

摘      要：Background: Compared with human leukocyte antigen (HLA)-matched sibling donor (MSD) transplantation, it remains unclear whether haploidentical donor (HID) transplantation has a superior graft-versus-leukemia (GVL) effect for Philadelphia-negative (Ph-) high-risk B-cell acute lymphoblastic leukemia (B-ALL). This study aimed to compare the GVL effect between HID and MSD transplantation for Ph- high-risk B-ALL.Methods: This study population came from two prospective multicenter trials (NCT01883180, NCT02673008). Immunosuppressant withdrawal and prophylactic or pre-emptive donor lymphocyte infusion (DLI) were administered in patients without active graft-versus-host disease (GVHD) to prevent relapse. All patients with measurable residual disease (MRD) positivity posttransplantation (post-MRD+) or non-remission (NR) pre-transplantation received prophylactic/pre-emptive interventions. The primary endpoint was the incidence of post-MRD+.Results: A total of 335 patients with Ph- high-risk B-ALL were enrolled, including 145 and 190, respectively, in the HID and MSD groups. The 3-year cumulative incidence of post-MRD+ was 27.2% (95% confidence interval [CI]: 20.2%-34.7%) and 42.6% (35.5%-49.6%) in the HID and MSD groups(P = 0.003), respectively. A total of 156 patients received DLI, including 60 (41.4%) and 96 (50.5%), respectively, in the HID and MSD groups (P= 0.096). The 3-year cumulative incidence of relapse was 18.6% (95% CI: 12.7%-25.4%) and 25.9% (19.9%-32.3%;P = 0.116) in the two groups, respectively. The 3-year overall survival (OS) was 67.4% (95% CI: 59.1%-74.4%) and 61.6% (54.2%-68.1%;P = 0.382), leukemia-free survival (LFS) was 63.4% (95% CI: 55.0%-70.7%) and 58.2% (50.8%-64.9%;P= 0.429), and GVHD-free/relapse-free survival (GRFS) was 51.7% (95% CI: 43.3%-59.5%) and 37.8% (30.9%-44.6%;P= 0.041), respectively, in the HID and MSD groups.Conclusion: HID transplantation has a lower incidence of post-MRD+ than MSD transplantation, suggesting that HID transplantation might have a superior GVL effect than MSD transplantation for Ph- high-risk B-ALL patients.Trial registration: ClinicalTrials.gov: NCT01883180, NCT02673008.