Prognoses of patients with hematological malignancies after haploidentical or HLA-matched sibling hematopoietic stem cell transplantation / 中华器官移植杂志

ABSTRACT

Objective To compare the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) and HLA-identical transplantation for hematologic diseases,and analyze risk factors related to overall survival (OS).Methods There were 81 patients with hematological malignancies receiving Allo-HSCT from October,2011 to July,2017.The patients were divided into two groups30 patients undergoing haploidentical HSCT and 51 cases undergoing matched sibling donor HSCT (MSD-HSCT).Implantations of hematopoietie stem cells,incidence of graft versus host disease (GVHD),OS rate,disease free survival (DFS) rate,incidence of relapse and non-relapsemortality were analyzed statistically.Multivariate analysis was used to analyze the risk factors related to OS.Results All patients achieved sustained engraftment.100 days after Allo-HSCT,thecumulative incidence for Ⅱ-Ⅳ aGVHD had no significant difference between haplo-HSCT and MSD-HSCT (56.7％ versus 11.8％,P =0.000).There was no significant difference in the 1-year cumulative incidence for cGVHD between haplo-HSCT and MSD-HSCT (20.6％ versus 45％,P =0.341).The 2-year OS rate in patients receiving haplo-HSCT and MSD-HSCT was 63.2％ and 78.4％ respectively (P =0.078).The 2-year DFS rate in patients receiving haplo-HSCT and MSD-HSCT was 54.8％ and 66.9％ respectively (P=0.159).The 2-year relapse and non-relapse-mortality rate in patients receiving haplo-HSCT and MSD-HSCT was 25.9％ and 24％,and 22.9％ and 9.5％ respectively.There were no statistically significant differences in relapse rate and mortality between two groups (P =0.465,0.118).Multivariate analysis showed that relapse and Ⅱ-Ⅳ aGVHD were independent prognostic indictors for OS with relative risk 6.671 (95％ CI 2.791-15.946) and 3.073 (95％ CI 1.296 ～ 7.284) (P ＜ 0.05).Conclusion The therapeutic effects of haploidentical transplantation were similar to those of HLA-identical sibling transplantation.Relapse and Ⅱ-Ⅳ aGVHD after transplantation have prognostic significance for the long-term survival of transplant patients.