The inferiority of G-PB to rhG-CSF-mobilized blood and marrow grafts as a stem cell source in patients with high-risk acute leukemia who underwent unmanipulated HLA-mismatched/haploidentical transplantation: a comparative analysis

Abstract

The purpose of this study was to investigate the efficacy and feasibility of unmanipulated haploidentical PBSCT for the treatment of acute leukemia (AL). This study compares the clinical outcomes of high-risk AL patients who received PBSCs harvested from family members sharing at least one common haplotype to outcomes of high-risk AL patients who received a mixture of G-CSFprimed BM (G-BM) and peripheral blood (G-PB) harvests. The results show that PBSCT achieved inferior cumulative myeloid engraftment at 30 days after transplant (89.9 ± 10.1% vs 100%; P ¼ 0.04), with lower cumulative incidence of grade II-IV acute GVHD (aGVHD) (37.1 ± 16.5% vs 63.2 ± 6%; P ¼ 0.058) compared with G-BM/G-PB transplant. However, both transplant protocols had similar rates of 2-year relapse (29.6±17.1% vs 34.0±5.7%; P ¼ 0.954), and PBSCT produced a higher incidence of 2-year non-leukemic mortality (62.5 ± 14.8% vs 35.1 ± 5.1%; P ¼ 0.014), as well as lower rates of overall (26.8±12.3% vs 43.2 ± 5.0%; P ¼ 0.052) and disease-free survival (26.8 ± 12.3% vs 42.4 ± 5.0%; P ¼ 0.071) compared with G-BM/G-PB transplant. These results suggest that haploidentical HSCT is an option for patients with AL who urgently need a graft and do not have matched sibling donors. PBSCT is potentially inferior to G-BM/G-PB transplant, and improvements should be made before PBSCT becomes a routine in unmanipulated mismatched/ haploidentical transplant settings.

Improved clinical outcomes of rhG-CSF-mobilized blood and marrow haploidentical transplantation compared to propensity score-matched rhG-CSF-primed peripheral blood stem cell haploidentical transplantation: a multicenter study

“…In accordance with our previous report (Xu et al, 2010;Zhao et al, 2013), there were trends of lower NRM and relapse rate in the GBM/GPB mixed stem cell source group than in the GPB graft group. Therefore, the GBM/GPB mixed harvest was superior to GPB in terms of overall survival in standard-risk patients.…”

“…Our previous single-center studies have demonstrated better survival after HBMT compared to haploidentical GPB allo-HSCT (HPBSCT) for high-risk acute leukemia (AL) (not in remission (NR) or in more than the second complete remission (>CR2)) (Xu et al, 2010). Which procedure is the optimal HSC graft for standard-risk hematological malignances (AL, multiple myeloma (MM), and non-Hodgkin lymphomas (NHL) in CR1/CR2 and patients with chronic myeloid leukemia (CML) in the first and second chronic phase (CP1/CP2)) remains unknown.…”

A novel protocol for haploidentical hematopoietic SCT without in vitro T-cell depletion in the treatment of severe acquired aplastic anemia

“…Several unique aspects of our protocol may have helped to facilitate engraftment. These aspects include (1) an intensified conditioning regimen that adds BU to CY þ ATG based on a previous report that the addition of low doses of BU to the standard conditioning regimen in HLAidentical sibling donor HSCT reduces rejection; 20 (2) the combination of G-BM and G-PB grafts work synergistically to enhance engraftment; [21][22][23] and (3) the employment of a more potent GVHD prophylactic treatment regimen using CsA, MTX and MMF.…”

New strategies for haploidentical transplantation

“…In this setting, the graft composition affected the clinical outcome, and a higher CD4/CD8 ratio in the G-CSF-primed BM was associated with a survival disadvantage and a trend toward relapse, whereas a lower CD4/CD8 ratio in primed BM was associated with a survival benefit (47). The use of G-CSF-mobilized PBSCs alone was inferior as compared with the use of G-CSF-primed BM and G-CSF-mobilized PBSCs (48). G-CSF-mobilized BM alone was used in pediatric patients with hematological malignancies after myeloablative conditioning.…”