HLA-10/10相合无关供者与同胞供者造血干细胞移植治疗成人急性髓系白血病疗效比较

OBJECTIVE: To evaluate the outcomes of human leukocyte antigen (HLA) matched unrelated donor hematopoietic stem cell transplantation (MUD-HSCT) for adult acute myeloid leukemia (AML) in a single center. METHODS: Consecutive adult AML who received MUD-HSCT in our center from January 2008 to April 2017 were studied retrospectively, comparing with patients undergoing matched sibling donor (MSD)-HSCT in the same period. The rates of overall survival (OS), disease free survival (DFS), relapse, non-relapse mortality (NRM), engraftment, acute and chronic graft-versus-host disease (aGVHD and cGVHD) were analyzed. RESULTS: A total of 247 consecutive cases were enrolled, including 46 patients with MUD-HSCT and 201 with MSD-HSCT. All the patients experienced neutrophil engraftment except for one patient who died early in the MSD group, but the median day of engraftment was longer in the MUD group (15.0 vs 14.0, P=0.017). The accumulative engraftment rate of platelet was comparable between the two groups (93.5% vs 98.0%, P=0.128). The accumulative incidences of aGVHD (50.0% vs 46.3%, P=0.421) and cGVHD (37.8% vs 43.0%, P=0.581) were not statistically different between the two groups. Compared with the MSD group, the accumulative NRM rate at+36 months after transplantation was significantly higher in the MUD group (22.0% vs 10.4%, P=0.049), while the relapse rate was not statistical difference (20.5 vs 28.3%, P=0.189). Both the 3-year OS (61.6% vs 63.3%, P=0.867) and DFS (57.5% vs 61.6%, P=0.760) were comparable between the two groups. Four independent risk factors were confirmed by the multivariate analysis: patient age ≥45 years old, CR2 or NR before transplantation, a history of extramedullary infiltration and the occurrence of grade Ⅲ–Ⅳ aGVHD. No statistical differences were demonstrated in the survival rate between MUD-and MSD-HSCT in different subgroups. CONCLUSION: The outcomes, such as GVHD, relapse, OS and DFS, were comparable between MUD-and MSD-HSCT for adult AML, but higher incidence of NRM and longer time to neutrophil engraftment in the MUD group. MUD-HSCT is practical and feasible for adult AML who are lack of MSD.