Comparative Study of the Efficacy of Allogeneic Hematopoietic Stem Cell Transplantation from Human Leukocyte Antigen-Haploidentical Related and Unrelated Donors in the Treatment of Leukemia

Abstract

Aims: To compare the efficacy of hematopoietic stem cell transplantation (HSCT) from human leukocyte antigen (HLA)-haploidentical related donors (RD) and unrelated donors (URD) in the treatment of leukemia. Methods: Ninety-three leukemia patients underwent allogeneic HSCT were divided into two groups: 51 cases of RD-HSCT and 42 cases of URD-HSCT. In the RD-HSCT group, a preconditioning regimen with fludarabine (Flu) + busulfan (Bu) + cytosine arabinoside (Ara-C) was used in 42 patients and total body irradiation (TBI) + Flu + Ara-C was used in the remaining 9. Results: In the URD-HSCT group, a modified preconditioning regimen with Bu + cyclophosphamide was used in 35 patients, while the other 7 patients underwent treatment with TBI + Flu. After transplantation, the occurrence rate of grade II-IV acute graft-versus-host disease (GVHD) was 46.0 and 51.2% in the two groups. Likewise, the rate of chronic GVHD was 46.0 and 63.4%, respectively. No significant differences in the occurrence of acute and chronic GVHD were detected between the two groups. The differences in early-stage infection rate after transplantation, recurrence rate, 3-year survival rate, and disease-free survival rate between the two groups were not significant. Conclusion: HLA-haploidentical RD-HSCT with enhanced preconditioning and administration of immunosuppressants showed a clinical efficacy similar to that of URD-HSCT against leukemia, without the risk of increased infection and GVHD.

The Effect of Haploidentical Hematopoietic Stem Cell Transplantation on Long Term Survival in Refractory Heavily Pretreated Hematologic Diseases

“…Sitoredüktif tedavi rejimi yedi hastada, fludarabin 30 mg/m 2 , ARA-C 2 gm/m 2 , amsakrin 100 mg/m 2…”

“…Bu çalışmada nakil ile ilişkili mortalite (NİM), haploidentik KHN'nin birinci nakil olduğu ya da ikinci nakil olduğu relaps refrakter lösemi hastalarıyla karşılaştırıldığında daha yüksektir (2,3,6,19). Bu durum hastalarda özellikle fungal enfeksiyona bağlı komorbiditeler ve CMV seropozitifliği ile açıklanabilir.…”

“…Ancak zamana karşı yarışan bu hasta grubu için doku tipi tam uyumlu verici bulunamadığında, en kolay ulaşılabilen hematopoietik kök hücre vericisi haploidentik kök hücre vericileridir. Tam uyumlu ADV ve haploidentik KHN'ler karşılaştırıldığında akut lösemili hastalarda benzer klinik etki saptanırken, graft versus host hastalığı (GVHH) oranları ve enfeksiyon sıklığında artış saptanmamıştır (2). Allojeneik KHN sonrası en büyük sorun relapsdır.…”