Causes of mortality after haploidentical hematopoietic stem cell transplantation and the comparison with HLA-identical sibling hematopoietic stem cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 51; no. 3; pp. 391 - 397
• Main Authors: Yan, C-H, Xu, L-P, Wang, F-r, Chen, H, Han, W, Wang, Yu, Wang, J-z, Liu, K-Y, Huang, X-J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2016; Nature Publishing Group
• Subjects: 692/308/174; 692/699/1541/1990; Adolescent; Adult; Aged; Analysis; Bone marrow; Causes of; Cell Biology; Child; Child, Preschool; Disease-Free Survival; Female; Health aspects; Health hazards; Health risks; Hematologic Neoplasms - mortality; Hematologic Neoplasms - therapy; Hematology; Hematopoietic Stem Cell Transplantation; Hematopoietic stem cells; Histocompatibility antigen HLA; HLA Antigens; Humans; Internal Medicine; Leukemia; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Multivariate analysis; Myelodysplastic syndrome; Myelodysplastic syndromes; original-article; Public Health; Siblings; Stem cell transplantation; Stem Cells; Survival Rate; Tissue Donors; Transplantation; United States; United States
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2015.306

This study was performed to investigate incidence, causes and factors influencing mortality after haploidentical hematopoietic stem cell transplantation (HSCT) and to compare differences between haploidentical HSCT and HLA-identical sibling HSCT. From January 2000 to June 2011, 1411 patients with acute leukemia or myelodysplastic syndrome were included in this study. Of these patients, 571 received HLA-identical sibling HSCT and 840 received haploidentical HSCT. The cumulative incidence of overall mortality and transplant-related mortality (TRM) after haploidentical HSCT was higher than those after HLA-identical sibling HSCT (38.7% vs 33.3%, P =0.012 and 27.5% vs 19.9%, P =0.002), but the incidence of relapse-related mortality (RRM) did not differ between the two groups (15.6% vs 16.7%, P =0.943). A multivariate analysis suggested that high-risk disease status and haploidentical HSCT correlated with a higher incidence of overall mortality ( P< 0.0001, hazard ratio=1.911 and P =0.019, hazard ratio=1.249); in addition, in haploidentical HSCT, only high-risk disease status correlated with a higher incidence of overall mortality ( P< 0.0001, hazard ratio=1.845). Our study suggested that haploidentical HSCT provided a higher incidence of overall mortality and TRM but the same incidence of RRM compared with HLA-identical sibling HSCT. Therefore, HLA-identical sibling HSCT remains the first choice, but haploidentical HSCT is available for patients without an HLA-identical sibling donor.