Unmanipulated haploidentical versus matched unrelated donor allogeneic stem cell transplantation in adult patients with acute myelogenous leukemia in first remission: a retrospective pair-matched comparative study of the Beijing approach with the EBMT database

摘要

For adult patients with intermediate-risk acute myelogenous leukemia (AML) in first complete remission (CR1), allogeneic stem cell transplantation (allo-SCT) has been demonstrated to be the best therapeutic option. The ideal donor is a HLA-genoidentical sibling. In the absence of a genoidentical donor, a HLA 10/10 or 8/8 matched unrelated donor (URD) is presently considered to be the best choice, taking advantage of the 25 million volunteer donors registered worldwide.~(~(1)) Although the probability of finding an unrelated donor has recently reached almost 80% for white Europeans, it still remains at around only 41% for Chinese patients.~(~(2)) Furthermore, while waiting for a volunteer donor, the risk of early relapse remains, highlighting the need for alternative sources of donors.Initially, haploidentical donor transplantation was pioneered by the Perugia team,~(~(3)) using selected megadose stem cells and highly myeloablative pre-transplant regimens. Recently, in the USA and then in Europe, a considerable improvement has occurred with the shift to T-cell replete grafts and the introduction of high-dose cyclophosphamide post-graft infusion for the prevention of graft versus host disease (GvHD).~(~(4)) In China, the Beijing group has pioneered a different approach with T-cell replete HID, intensive myeloablation, a combination of G-CSF-primed bone marrow plus peripheral blood as the stem cell source, and anti-thymocyte globulins (ATGs).~(~(5)) This team has reported a large series of haploidentical transplants for AML in CR1, with leukemia-free survival (LFS) as high as 70% and a very low incidence of both acute and chronic GvHD.