Favorable outcome of haploidentical hematopoietic stem cell transplantation in Philadelphia chromosome-positive acute lymphoblastic leukemia: a multicenter study in Southwest ChinaReportar como inadecuado




Favorable outcome of haploidentical hematopoietic stem cell transplantation in Philadelphia chromosome-positive acute lymphoblastic leukemia: a multicenter study in Southwest China - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Journal of Hematology and Oncology

, 8:90

First Online: 26 July 2015Received: 08 April 2015Accepted: 08 July 2015DOI: 10.1186-s13045-015-0186-5

Cite this article as: Gao, L., Zhang, C., Gao, L. et al. J Hematol Oncol 2015 8: 90. doi:10.1186-s13045-015-0186-5

Abstract

BackgroundSince the introduction of tyrosine kinase inhibitors TKIs into combination chemotherapy regimens, the majority of newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia Ph+ ALL patients have achieved complete remission CR. However, without allogeneic hematopoietic stem cell transplantation HSCT, long-term outcomes in adults remain unsatisfactory. Indeed, haploidentical HSCT has become a common treatment for adult patients who lack an HLA-matched donor, though limited data are available on the efficacy of haploidentical HSCT in Ph+ ALL patients.

MethodsWe analyzed the clinical outcomes of 82 Ph+ ALL patients who underwent haploidentical HSCT n = 47 or HLA-matched HSCT n = 35. Real-time quantitative reverse transcription polymerase chain reaction qRT-PCR was performed to assess BCR-ABL expression. All of the patients were treated with an imatinib-based regimen before undergoing HSCT. Imatinib treatment was resumed in the patients’ posttransplantation following detection of BCR-ABL transcripts.

ResultsAll of the patients achieved neutrophil and platelet engraftment, with the exception of five patients who died prior to engraftment. Haploidentical HSCT was associated with higher incidences of acute graft-versus-host disease GVHD 51.1 vs. 25.7 %, p < 0.05 and chronic GVHD 48.9 vs. 25.7 %, p < 0.05 compared with HLA-matched HSCT, but there was no difference in the incidence of either grades III–IV acute GVHD or extensive chronic GVHD. The incidence of cytomegalovirus CMV infection was significantly higher in the patients treated with haploidentical HSCT than in those treated with HLA-matched HSCT 38.3 vs. 14.3 %, p < 0.05. Haploidentical HSCT was associated with a significantly lower relapse rate compared with HLA-matched HSCT 44.8 vs. 19.1 %, p < 0.05. There were no differences in non-relapse mortality NRM, leukemia-free survival LFS, or overall survival OS between the patients who received HLA-matched HSCT and those who underwent haploidentical HSCT.

ConclusionsOur data indicate that the incidence of NRM after HSCT is similar between the patients who receive HLA-matched donor cells and those who receive haploidentical donor cells and that haploidentical HSCT reduces the relapse rate. Haploidentical HSCT represents an encouraging treatment option for Ph+ ALL patients who lack a suitable HLA-matched donor.

AbbreviationsaGVHDacute graft-versus-host disease

allo-HSCTallogeneic hematopoietic stem cell transplantation

ANCabsolute neutrophil count

Ara-Carabinosylcytosine

ATGanti-thymocyte globulin

BMbone marrow

Bubusulfan

cGVHDchronic graft-versus-host disease

CMVcytomegalovirus

CRcomplete remission

CR1first complete remission

CsAcyclosporin

CYcyclophosphamide

FBfludarabine and busulfan

FK506tacrolimus

G-BMmobilize stem cells in the bone marrow

G-CSFgranulocyte colony stimulating factor

G-PBmobilize stem cells in the peripheral blood

GVHDgraft-versus-host disease

GVLgraft-versus-leukemia

HRQoLhealth-related quality of life

HSCThematopoietic stem cell transplantation

HVODhepatic venous occlusive disease

LFSleukemia-free survival

MMFmycophenolate mofetil

MNCsmononuclear cells

MTXmethotrexate

NRMnon-relapse mortality

OSoverall survival

PBperipheral blood

PBMCperipheral blood mononuclear cell

Ph+ ALLPhiladelphia chromosome-positive acute lymphoblastic leukemia

qRT-PCRreal-time quantitative reverse transcription polymerase chain reaction

TBItotal-body irradiation

TKItyrosine kinase inhibitors

TRTtransplantation-related toxicity

WBCwhite blood cell

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Autor: Li Gao - Cheng Zhang - Lei Gao - Yao Liu - Yi Su - Sanbin Wang - Bin Li - Tonghua Yang - Zhong Yuan - Xi Zhang

Fuente: https://link.springer.com/







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