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The long-term outcome of reduced-intensity allogeneic stem cell transplantation from a matched related or unrelated donor, or haploidentical family donor in patients with leukemia: a retrospective analysis of data from the China RIC Cooperative Group

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Abstract

This study compared 6-year follow-up data from patients undergoing reduced-intensity conditioning (RIC) transplantation with an HLA-matched related donor (MRD), an HLA-matched unrelated donor (MUD), or an HLA-haploidentical donor (HID) for leukemia. Four hundred and twenty-seven patients from the China RIC Cooperative Group were enrolled, including 301 in the MRD, 79 in the HID, and 47 in the MUD groups. The conditioning regimen involved fludarabine combined with anti-lymphocyte globulin and cyclophosphamide. Graft-versus-host disease (GVHD) prophylaxis was administered using cyclosporin A (CsA) and mycophenolate mofetil (MMF). Four hundred and nineteen patients achieved stable donor chimerism. The incidence of stage II-IV acute GVHD in the HID group was 44.3 %, significantly higher than that in the MRD (23.6 %) and MUD (19.1 %) groups. The 1-year transplantation-related mortality (TRM) rates were 44.3, 17.6, and 21.3, respectively. Event-free survival (EFS) at 6 years in the HID group was 36.7 %, significantly lower than that of the MRD and MUD groups (59.1 and 66.0 %, P < 0.001 and P = 0.001, respectively). For advanced leukemia, the relapse rate of the HID group was 18.5 %, lower than that of the MRD group (37.5 %, P = 0.05), but the EFS at 6 years was 31.7 and 30.4 % (P > 0.05), respectively. RIC transplantation with MRD and MUD had similar outcome in leukemia which is better than that with HID. RIC transplantation with HID had lower relapsed with higher TRM and GVHD rate, particularly in advanced leukemias. RIC transplantation with MRD and MUD had similar outcomes in leukemia and they were better than those with HID. RIC transplantation with HID had a lower relapse rate but higher TRM and GVHD rates, particularly in cases of advanced leukemia.

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Author’ contribution

Dr. Hui-Sheng Ai, as principal investigator, had full access of all the data in this study and take responsibility of integrity of the data and accuracy of data analysis. Study concept and design: Hui-Sheng Ai. Acquisition of data: Chang-Lin Yu, Zheng-Dong, Zhen-Hua Qiao, Jian-Min Wang, Huang-He, Ying-Min Liang, De-Pei Wu, Bao-An Chen, Bai-Hai, Bao-Fu Shi, Wan-Jun Sun, Jun-Xiao Qiao, Mei Guo, Jian-Hui Qiao, Qi-Yun Sun, Kai-Xun Hu, Ya-Jing Huang, Hong-li Zuo, Xiao-Jun Huang, Hui-Sheng Ai. Analysis and interpretation of data: Hui-Sheng Ai, Chang-Lin Yu, Zheng-Dong. Drafting of the manuscript: Hui-Sheng Ai, Chang-Lin Yu, Zheng-Dong,. Critical revision of the manuscript for important intellectual content: Hui-Sheng Ai, Chang-Lin Yu, Zheng-Dong. Statistical expertise: Hui-Sheng Ai, Chang-Lin Yu, Zheng-Dong. Obtained funding: Hui-Sheng Ai. Administrative, technical, or material support: Chang-Lin Yu, Zheng-Dong, Zhen-Hua Qiao, Jian-Min Wang, Huang-He, Ying-Min Liang, De-Pei Wu, Bao-An Chen, Bai-Hai, Bao-Fu Shi, Wan-Jun Sun, Hui-Sheng Ai. Supervision: Hui-Sheng Ai.

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    Authors and Affiliations

    1. Department of Hematology and Transplantation, Affiliated Hospital of the Academy of Military Medical Sciences, 8 Dongdajie, Beijing, 100071, China

      Chang-Lin Yu,  Zheng-Dong, Mei Guo, Jian-Hui Qiao, Qi-Yun Sun, Kai-Xun Hu, Ya-Jing Huang, Hong-li Zuo & Hui-Sheng Ai

    2. Second Hospital of Shanxi Medical University, Taiyuan, China

      Zhen-Hua Qiao

    3. Chang Hai Hospital of Shanghai Second Military Medical University, Shanghai, China

      Jian-Min Wang

    4. Affiliated Hospital of Zhejiang University, Hangzhou, China

      Huang-He

    5. Tang-Du Hospital of Fourth Military Medical University, Xi’an, China

      Ying-Min Liang

    6. Affiliated Hospital of Suzhou University, Suzhou, China

      De-Pei Wu

    7. Affiliated Zhongda Hospital of Southeast University, Nanjing, China

      Bao-An Chen

    8. Lanzhou General Hospital in Lanzhou Military Area Command, Lanzhou, China

      Bai-Hai

    9. 201 Hospital Shenyang, Shenyang, China

      Bao-Fu Shi

    10. Second Artillery General Hospital, Beijing, China

      Wan-Jun Sun & Jun-Xiao Qiao

    11. Department of Hematology and Transplantation, People’s Hospital Under Beijing University, Beijing, 100044, China

      Xiao-Jun Huang

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    1. Chang-Lin Yu
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    Correspondence to Xiao-Jun Huang or Hui-Sheng Ai.

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    This work was supported by grants from the “National Natural Foundation of China” (no. 81130054) and the National Basic Research Program of China (973 Program, No 2010CB529404).

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    No competing financial interests. Role of the sponsor: The funding agencies/sponsors had no role in data collection, analysis, manuscript preparation, or authorization for publication.

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    Chang-Lin Yu and Zheng-Dong contributed equally to this work.

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    Yu, CL., Zheng-Dong, Qiao, ZH. et al. The long-term outcome of reduced-intensity allogeneic stem cell transplantation from a matched related or unrelated donor, or haploidentical family donor in patients with leukemia: a retrospective analysis of data from the China RIC Cooperative Group. Ann Hematol 96, 279–288 (2017). https://doi.org/10.1007/s00277-016-2864-y

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