The consensus on the monitoring, treatment, and prevention of leukemia relapse after allogeneic hematopoietic stem cell transplantation in China

Wang, Yu; Chen, Hu; Chen, Jing; Han, Mingzhe; Hu, Jianda; Hu, Jiong; Huang, He; Lai, Yongrong; Liu, Dai‐Hong; Liu, Qifa; Liu, Ting; Jiang, Ming; Ren, Hanyun; Song, Yongping; Sun, Zimin; Wang, Chun; Wang, Jianmin; Wu, Depei; Xu, Kailin; Zhang, Xi; Xu, Lei; Liu, Kai-Yan; Huang, Xiao‐Jun

doi:10.1016/j.canlet.2018.08.030

Cited by 107 publications

(88 citation statements)

References 106 publications

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“…In the current study, the difference in the cumulative incidences of grades II‐IV and III‐IV aGVHD and cGVHD was not significant between the ISD‐SCT group and the HID‐SCT group but there were trends that HID‐SCT led to higher rates of GVHD than ISD‐SCT, which were aligned with the findings from a previous study [9]. However, our previous studies showed that HID‐SCT resulted in a comparable rate of GVHD as ISD‐SCT in pediatric and adult recipients [31‐33]. This may be due to the small number of patients, especially in the ISD‐SCT group.…”

Section: Discussionsupporting

confidence: 89%

“…Future studies should involve both MRD and information of donor lymphocyte infusion to analyze data in more details. Last, although we conducted matched pair analysis to reduce selection bias, the sample size of the ISD‐SCT group was small, which could partially explain the slightly different results with our previous studies [9, 31, 32, 33].…”

Section: Discussionmentioning

confidence: 83%

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Haploidentical‐ versus identical‐sibling transplant for high‐risk pediatric AML: A multi‐center study

Zheng

Zhang

et al. 2020

Cancer Communications

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Background Human leukocyte antigen‐identical sibling donor (ISD)‐hematopoietic stem cell transplantation (SCT) is a potentially curative treatment for high‐risk pediatric acute myeloid leukemia (AML). A haploidentical donor (HID) is readily available to almost all children. Previous studies have demonstrated that patients with HID‐SCT had similar outcomes compared to ISD‐SCT for pediatric and adult AML. However, the role of HID‐SCT in high‐risk pediatric AML is unclear. Methods To compare the overall survival of high‐risk AML children who underwent either HID‐SCT or ISD‐SCT, we analyzed 179 cases of high‐risk AML patients under 18 years of age treated with either ISD‐SCT (n = 23) or HID‐SCT (n = 156). Granulocyte colony‐stimulating factor plus anti‐thymocyte globulin‐based regimens were used for HID‐SCT. We also analyzed the subgroup data of AML patients at first complete remission (CR1) before SCT with known cytogenetic risk. Results The numbers of adverse cytogenetic risk recipients were 8 (34.8%) and 13 (18.8%) in the ISD‐SCT group and the HID‐SCT group, and the number of patients with disease status beyond CR1 were 6 (26.1%) and 14 (20.3%) in the two groups. The cumulative rates of grades II‐IV acute graft‐versus‐host disease (GVHD) were 13.0% in the ISD‐SCT group and 34.8% in the HID‐SCT group (P = 0.062), with a three‐year cumulative rates of chronic GVHD at 14.1% and 34.9%, respectively (P = 0.091). The relapse rate in the ISD‐SCT group was significantly higher than that in the HID‐SCT group (39.1% vs. 16.4%, P = 0.027); with non‐relapse mortality at 0.0% and 10.6% (P = 0.113), respectively. The three‐year overall survival rates were 73.0% for the ISD‐SCT group and 74.6% for the HID‐SCT group (P = 0.689). In subgroup analysis, the three‐year relapse rate in the ISD‐SCT group was higher than that in the HID‐SCT group (50.0% vs. 9.2%, P = 0.001) and the three‐year DFS in the ISD‐SCT group (50.0%) was lower than that in the HID‐SCT group (81.2%) (P = 0.021). Conclusions Unmanipulated HID‐SCT achieved DFS and OS outcomes comparable to those of ISD‐SCT for high‐risk pediatric AML patients with potentially higher rate but manageable GVHD.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 83%

Haploidentical‐ versus identical‐sibling transplant for high‐risk pediatric AML: A multi‐center study

Zheng

Zhang

et al. 2020

Cancer Communications

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“…The study protocol was approved by the Institutional Review Board of each center and was in accordance with the Declaration of Helsinki. Patients were defined as having low-, intermediate-, or high-risk disease stages according to the established disease risk index [21,22]. Exclusion criteria were contraindications to HCT such as severe heart, kidney, or liver function failure and a prior transplant.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

“…WT1-positive was defined as a transcript level > 0.60% in ≥ 1 bone marrow samples. Subjects were defined as MRD positive if they were both FCM and WT1 positive in a single sample [22]. The chimerism of leukocytes was analyzed post-transplant utilizing polymerase chain reaction amplification of short tandem repeats (PCR-STR).…”

Section: Transplant Proceduresmentioning

confidence: 99%

Low-dose post-transplant cyclophosphamide and anti-thymocyte globulin as an effective strategy for GVHD prevention in haploidentical patients

Wang

Liu

et al. 2019

J Hematol Oncol

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Background: Low-dose post-transplant cyclophosphamide (PTCy) in conjunction with anti-thymocyte globulin (ATG) appears as a potentially effective graft-versus-host disease (GVHD) prevention strategy in haploidentical hematopoietic cell transplant (haplo-HCT). Our study aims to assess the efficacy of this regimen. Methods:We extended our prospective study in patients treated with low-dose PTCy (14.5 mg/kg on days 3 and 4) in ATG/granulocyte colony-stimulating factor (G-CSF)-based regimen and compared the results to the contemporary cohort of patients without low-dose PTCy (ATG cohort). Both study cohort and control are transplanted from maternal donor or collateral relatives. Results: We identified 239 consecutive patients (ATG-PTCy cohort = 114; ATG cohort = 125). All patients but one in ATG cohort achieved myeloid engraftment by day 30 post-HCT. We found that both the cumulative incidence of 100-day grade III-IV aGvHD and non-relapse-mortality (NRM) in the ATG-PTCy cohort was significantly reduced than that in the ATG group (5% vs 18%; P = 0.003; and 6% vs 15%; P= 0.045); the 2-year cumulative incidences of relapse and overall survival were comparable between the two cohorts (13% vs 14%; P = 0.62; and 83% vs 77%; P = 0.18, respectively). Furthermore, GVHD-free, relapse-free survival (GRFS) was significantly improved in the ATG-PTCy arm (63% vs 48%; P = 0.039). In multivariate analysis, the joint treatment resulted in lower grade II-IV acute GVHD (HR 0.58; P = 0.036), grade III-IV aGvHD (HR 0.28; P = 0.006), chronic GVHD (HR 0.60; P = 0.047), NRM (HR 0.26; P = 0.014), and higher GRFS (HR 0.59; P = 0.021) but slower myeloid and platelet recovery (HR 0.29 and 0.30; both P < 0.001). Conclusions: These results suggested that ATG/PTCy (low-dose) can reduce both acute and chronic GVHD as compared with standard ATG-based prophylaxis using maternal donor or collateral relatives at particular high GVHD risk.

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“…In addition, an unrelated donor (URD) is not always found. Different modalities of T‐replete haploidentical HCT for haematological malignancies were reported to have similar outcomes compared with MSD or URD (Lu et al ., ; Bashey et al ., ; Raiola et al ., ; Wang et al ., ; Wang et al ., ; Wang et al ., ; Wang et al ., ). These data suggest donor source and HLA‐matching are not significantly correlated with transplant outcomes in these settings.…”

mentioning

confidence: 97%

Improved survival after offspring donor transplant compared with older aged‐matched siblings for older leukaemia patients

Wang

Liu

et al. 2019

Br J Haematol

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Summary Donor selection for older leukaemia patients undergoing haematopoietic cell transplant (HCT) is not well defined: outcomes might be improved with a younger offspring donor rather than an older human leukocyte antigen (HLA)‐matched sibling donor (MSD). We extended our multicentre dataset. A total of 185 acute leukaemia patients (≥ 50 years) transplanted in first complete remission who received HCT from offspring (n = 62) or MSD (n = 123) were included. A 1:1 ratio matched‐pair analysis was performed. We were able to match 54 offspring with 54 MSD patients. Outcomes were compared between the two matched‐pair groups. The cumulative incidence of grade II/IV acute graft‐versus‐host disease (GVHD) (26% vs. 35%; P = 0·23) and chronic GVHD (37% vs. 24%; P = 0·19) was comparable between groups (MSD vs. offspring). The lower three‐year transplant‐related mortality (9% vs. 26%; P = 0·023) and relapse incidence (6% vs. 17%; P = 0·066) resulted in higher overall survival (85% vs. 58%; P = 0·003) and leukaemia‐free survival (LFS) (85% vs. 56%; P = 0·001) in offspring HCT compared with that in MSD HCT. These data might favour a young offspring over an older MSD in patients >50 years. The current analyses confirm that non‐HLA donor characteristics, such as kinship and donor age, rather than HLA disparity, predominantly influence survival in older acute leukaemia patients.

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The consensus on the monitoring, treatment, and prevention of leukemia relapse after allogeneic hematopoietic stem cell transplantation in China

Cited by 107 publications

References 106 publications

Haploidentical‐ versus identical‐sibling transplant for high‐risk pediatric AML: A multi‐center study

Haploidentical‐ versus identical‐sibling transplant for high‐risk pediatric AML: A multi‐center study

Low-dose post-transplant cyclophosphamide and anti-thymocyte globulin as an effective strategy for GVHD prevention in haploidentical patients

Improved survival after offspring donor transplant compared with older aged‐matched siblings for older leukaemia patients

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