Objective To explore the clinical outcome of HLA haploidentical vs HLA-matcbed peripheral
blood hematopoietic stem cell transplantation (PBSCT) without
in vitro T-cell depletion for malignant
hematological diseases .
Methods 111
patients with malignant
hematological diseases underwent PBSCT without
in vitro T-cell depletion between May 2004 and February 2009, including 51
patients with HLA-haploidentical and 60
patients with HLA-matched. All
patients have received myeloablative conditioning regimen. A two-agent based
graft-versus-host disease (GVHD) prophylaxis was used as
cyclosporine A and a short
course of
methotrexate . Mycophenolate mofetile was added for the
patients with one locus mismatch. Mycophenolate mofetile,
antithymocyte globulin and CD25
monoclonal antibody were added for the
patients with 2-3 loci mismatch. The
grafts were
granulocyte colony-stimulating factor -mobilized
peripheral blood stem cells without
in vitro T-cell depletion. Results 111
patients achieved sustained and full
donor -type engraftment. The median
time to reach an absolute
neutrophil count above 0.5×10~9/L was 14 days and that to a
platelet count exceeding 20×10~9/L was 15 days in 51 HLA-haploidentical
patients , and that was 12 days and 13 days in 60 HLA-matched
patients , respectively. In 51 HLA-haploidentical
patients , 25
patients developed aGVHD, including 20 cases of grade Ⅰ aGVHD, and 5 cases of grade Ⅱ. Thirty-three
patients developed cGVHD with limited in 30 and extensive in 3. The 4-year
cumulative incidence of cGVHD was 70.4 %. The 3-year
probabilities of
leukemia -free
survival (LFS) were 74.5% (77.3 % for standard
risk patients and 68.2 % for high
risk patients respectively). Seven
patients had
recurrence . In 60 HLA-matched
patients , 14
patients developed aGVHD, including 10 cases of grade Ⅰ, 2 cases of grade Ⅱ and 2 cases of grade Ⅲ. Thirty-seven
patients developed cGVHD with limited in 32 and extensive in 5. The 4-year
cumulative incidence of cGVHD was 58.1%. The 3-year
probabilities of LFS were 72.1% (77.6 % for standard
risk patients and 52.7 % for high
risk patients respectively). Ten
patients had
recurrence . The
incidence of aGVHD in HLA-haploidentical cohort was significantly higher than in HLA-matched cohort (P<0.05). There was no significant difference in
incidence of cGVHD,
incidence of
relapse and LFS between HLA-haploidentical and HLA-matched cohorts (P>0.05). Conclusion Haploidentical PBSCT is feasible and safe for malignant
hematological diseases to use myeloablative conditioning regimen in combination with intensive
immunosuppressants without
in vitro T cell depletion.